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Cheng BT, Kim AB, Nadimpalli S, Pineles SL, Kurup SP. Association of Pediatric Strabismus and Functional Impairment: A Cross-sectional Nationwide Analysis. J Pediatr Ophthalmol Strabismus 2022:1-9. [PMID: 36102269 DOI: 10.3928/01913913-20220728-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the association of childhood strabismus with functional limitation to identify particular domains of impairment. METHODS The authors analyzed 201 children ages 5 to 17 years with strabismus enrolled in the 1996-2015 Medical Expenditure Panel Surveys, representative annual surveys of the U.S. POPULATION Functional impairment was assessed using the Columbia Impairment Scale (CIS), a validated measure of behavioral and psychosocial functioning. A CIS score of 16 or greater defined clinically significant functional impairment. Multivariate regression models adjusted for age, sex, race, ethnicity, household income, geographic location, and insurance type were constructed to examine the association of strabismus diagnosis with overall impairment and individual domains of function. RESULTS Children diagnosed as having strabismus had higher rates of clinically significant functional impairment compared to those without strabismus (15.1% vs 9.1%, adjusted odds ratio [95% CI]: 1.82 [1.11 to 2.97], P = .02). Moreover, strabismus diagnosis was associated with higher rates of problems with getting along with their mother (1.70 [1.21 to 2.40], P = .003) and father (1.66 [1.16 to 2.38], P = .006), getting along with other children (1.67 [1.16 to 2.40], P = .006), behavior at home (1.94 [1.37 to 2.74], P = .0002), staying out of trouble (1.52 [1.04 to 2.23], P = .03), nervousness (1.49 [1.05 to 2.11], P = .02), and getting involved with sports and hobbies (1.55 [1.03 to 2.34], P = .04). CONCLUSIONS Childhood strabismus is associated with 1.8-fold greater odds of clinically significant functional impairment, with greater dysfunction in specific relationship and behavioral domains. Functional burden may be an important consideration in management decisions. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Abstract
BACKGROUND The impact of childhood atopic dermatitis (AD) on social and behavioral issues is not well understood. OBJECTIVE This study sought to determine the prevalence and predictors of social and behavioral symptoms and functional impairment among US children with AD. METHODS The 1996 to 2015 Medical Expenditure Panel Surveys were analyzed, including a representative, cross-sectional study of 2553 US children with AD. Behavioral and functional issues were examined using Columbia Impairment Scale (CIS) scores. RESULTS Childhood AD was associated with behavioral and functional problems, particularly nervousness (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.06-1.31), home behavior (OR, 1.18; 95% CI, 1.06-1.32), staying out of trouble (OR, 1.18; 95% confidence interval, 1.06-1.31), and relationships with other kids (OR, 1.17; 95% CI, 1.05-1.31) and with siblings (OR, 1.14; 95% CI, 1.02-1.28). Higher CIS scores were present in children with AD versus without AD (adjusted β, 0.62; 95% CI, 0.22-1.02) and with psoriasis (adjusted β, 0.86; 95% CI, 0.22-1.49). Among children with AD, higher CIS scores were notably associated with male sex, older age, lower household income, public insurance, and comorbid depression and anxiety. CONCLUSIONS AD was associated with behavioral and functional impairment, similar to psoriasis and other common chronic conditions. There are significant sociodemographic differences in CIS scores.
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Cheng BT, Smith SS, Fishbein AB. Functional burden and limitations in children with chronic sinusitis. Pediatr Allergy Immunol 2020; 31:103-105. [PMID: 31505054 PMCID: PMC7444026 DOI: 10.1111/pai.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brian T Cheng
- Department of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie S Smith
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna B Fishbein
- Department of Pediatrics and Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Attell BK, Cappelli C, Manteuffel B, Li H. Measuring Functional Impairment in Children and Adolescents: Psychometric Properties of the Columbia Impairment Scale (CIS). Eval Health Prof 2018; 43:3-15. [PMID: 29788789 DOI: 10.1177/0163278718775797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The role of measuring functional impairment holds an important place in research, clinical practice, and service provision for children and adolescents. Responding to the growing need to measure serious emotional disturbances at the local, state, and national level, the Columbia Impairment Scale (CIS) was developed in the early 1990s and has remained one of the several popular scales for assessing functional impairment. However, despite the growing popularity of the instrument in research and practice, only a few studies to date have specifically examined the psychometric properties of the CIS. In this article, we describe the results of the first item response theory analysis of the CIS utilizing nationally representative data from the Medical Expenditure Panel Survey (N = 69,966). The results of our analysis lend support to the essential unidimensionality of the CIS and demonstrate that the scale is most reliable for those who exhibit high levels of functional impairment. Given the psychometric properties of the scale identified by our analysis, we contend that the CIS is a viable measure in the ongoing efforts to establish a national epidemiologic surveillance system to track the prevalence and impact of serious emotional disturbances in children and adolescents.
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Affiliation(s)
- Brandon K Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | - Christopher Cappelli
- Center for Education Integrating Science, Mathematics, and Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Hongli Li
- Department of Educational Policy Studies, Georgia State University, Atlanta, GA, USA
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Cook BL, Carson NJ, Kafali EN, Valentine A, Rueda JD, Coe-Odess S, Busch S. Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment. Gen Hosp Psychiatry 2017; 45:32-39. [PMID: 28274336 PMCID: PMC7598773 DOI: 10.1016/j.genhosppsych.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescribing among white youth, under-prescribing among minority youth, or both. To build evidence in this area, this study examined racial/ethnic differences in the prescription of psychotropic medications among youth with and without psychological impairment. METHODS Secondary data on two-year medication use from the 2004-2011 Medical Expenditure Panel Surveys were analyzed. We capitalized on two-year panel data, creating variables that allow for differential sequencing of psychological impairment and medication prescription (e.g., impairment in year 1 or year 2, and a psychotropic medication fill in year 2). Statistical differences were determined using unadjusted rate comparisons and logistic regression models, after adjustment for socio-contextual and health status characteristics. RESULTS Compared to Black and Latino youth with psychological impairment, White youth were more likely to be prescribed psychotropic medications when impaired. Among youth never having psychological impairment, White youth were also more likely to be prescribed medications compared to their racial/ethnic minority counterparts. CONCLUSIONS Differences in rates of medication use among youth with and without impairment suggest poor medication targeting across racial/ethnic groups. These results, combined with recent psychotropic medication risk warnings and concerns over increases in psychotropic medication use among youth, suggest that a continued emphasis on accurate targeting of prescribing patterns is needed across racial/ethnic groups.
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Affiliation(s)
- Benjamin Lê Cook
- Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States; Department of Psychiatry, Harvard Medical School, United States.
| | - Nicholas J. Carson
- Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States,Department of Psychiatry, Harvard Medical School, United States
| | | | - Anne Valentine
- Heller School for Social Policy and Management, United States.
| | | | | | - Susan Busch
- Yale School of Public Health, United States.
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Lavigne JV, Meyers KM, Feldman M. Systematic Review: Classification Accuracy of Behavioral Screening Measures for Use in Integrated Primary Care Settings. J Pediatr Psychol 2016; 41:1091-1109. [DOI: 10.1093/jpepsy/jsw049] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 05/04/2016] [Indexed: 11/14/2022] Open
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Abstract
This study examined the incidence of adverse prenatal, perinatal, and neonatal experiences amongst children with anxiety disorders, and the relationship to clinical symptomology and functional impairment in treatment-seeking children (N = 107) with a primary anxiety disorder. Anxious children had higher rates of reported maternal prescription medication use during pregnancy, maternal smoking and illness during pregnancy and neonatal complications (including neonatal intensive care and feeding issues) compared with population base rates and non-affected children. Almost one-third had early problems with sleep. Developmental problems were common with more than half having at least one area of delay. More than three quarters of anxious children had a first-degree family member with a psychiatric history. There were several associations between neonatal complications and subsequent clinical symptomology, including attention deficit hyperactivity disorder and depressive comorbidity, anxiety severity and functional impairment. Findings suggest higher rates of perinatal complications in anxious children.
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Thomas KC, Williams CS, deJong N, Morrissey JP. Examination of Parent Insurance Ratings, Child Expenditures, and Financial Burden Among Children With Autism: A Mismatch Suggests New Hypotheses to Test. Pediatrics 2016; 137 Suppl 2:S186-95. [PMID: 26908474 DOI: 10.1542/peds.2015-2851q] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Families raising children with autism contribute significant amounts to the cost of care. In this era of health care reform, families have more insurance choices, but people are unfamiliar with health insurance terms. This study uses 2 national data sets to examine health insurance ratings from parents raising children with autism and child expenditures to explore how these measures align. METHODS Children with autism who met criteria for special health care needs and were continuously insured were examined. Data from the National Survey of Children With Special Health Care Needs 2009-2010 were used to examine parent report of adequate insurance (n = 3702). Pooled data from the Medical Expenditure Panel Survey 2002-2011 were used to examine expenditures (n = 346). Types of health insurance included private alone, Medicaid alone, and combined private and wrap-around Medicaid. RESULTS Having Medicaid doubled the odds of reporting adequate insurance compared with private insurance alone (P < .0001), and children on Medicaid had the lowest out-of-pocket costs ($150, P < .0001). Children covered by combined private and wrap-around Medicaid had the highest total expenditures ($11 596, P < .05) and the highest expenditures paid by their insurance ($10 638, P < .05). CONCLUSIONS These findings highlight a mismatch between parent ratings of insurance adequacy, child expenditures, and relative financial burden. Findings generate a number of questions to address within single sources of data. By elaborating the frameworks families use to judge the adequacy of their insurance, future research can develop policy strategies to improve both their satisfaction with their insurance coverage and the service use of children with autism.
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Affiliation(s)
- Kathleen C Thomas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
| | - Christianna S Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neal deJong
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; and
| | - Joseph P Morrissey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
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Abstract
BACKGROUND Increasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment. METHODS We analyzed the 1996-1998, 2003-2005, and 2010-2012 Medical Expenditure Panel Surveys, which were nationally representative surveys of U.S. households, for trends in outpatient use of mental health services by persons 6 to 17 years of age; 53,622 persons were included in the analysis. Mental health impairment was measured with the use of the Columbia Impairment Scale (range, 0 to 52, with higher scores indicating more severe impairment); we classified youths with scores of 16 or higher as having more severe impairment and those with scores of less than 16 as having less severe impairment. RESULTS The percentage of youths receiving any outpatient mental health service increased from 9.2% in 1996-1998 to 13.3% in 2010-2012 (odds ratio, 1.52; 95% confidence interval, 1.35 to 1.72). The proportionate increase in the use of mental health services among youths with more severe impairment (from 26.2% to 43.9%) was larger than that among youths with less severe or no impairment (from 6.7% to 9.6%). However, the absolute increase in annual service use was larger among youths with less severe or no impairment (from 2.74 million to 4.19 million) than among those with more severe impairment (from 1.56 million to 2.28 million). Significant overall increases occurred in the use of psychotherapy (from 4.2% to 6.0%) and psychotropic medications (from 5.5% to 8.9%), including stimulants and related medications (from 4.0% to 6.6%), antidepressants (from 1.5% to 2.6%), and antipsychotic drugs (from 0.2% to 1.2%). CONCLUSIONS Outpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996-1998 and 2010-2012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet fewer than half accessed services in 2010-2012. (Funded by the Agency for Healthcare Research and Quality and the New York State Psychiatric Institute.).
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Affiliation(s)
- Mark Olfson
- From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute - both in New York (M.O.); the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (B.G.D.); and the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the School of Social Practice and Policy, University of Pennsylvania - both in Philadelphia (S.C.M.)
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Psychosocial profile of a sample of Egyptian children with rheumatic heart disease. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000461678.30239.4f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Healthcare Expenditures for Autism During Times of School Transition: Some Vulnerable Families Fall Behind. Matern Child Health J 2014; 18:1936-44. [DOI: 10.1007/s10995-014-1439-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fiks AG, Mayne S, Localio AR, Feudtner C, Alessandrini EA, Guevara JP. Shared decision making and behavioral impairment: a national study among children with special health care needs. BMC Pediatr 2012; 12:153. [PMID: 22998626 PMCID: PMC3470977 DOI: 10.1186/1471-2431-12-153] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background The Institute of Medicine has prioritized shared decision making (SDM), yet little is known about the impact of SDM over time on behavioral outcomes for children. This study examined the longitudinal association of SDM with behavioral impairment among children with special health care needs (CSHCN). Method CSHCN aged 5-17 years in the 2002-2006 Medical Expenditure Panel Survey were followed for 2 years. The validated Columbia Impairment Scale measured impairment. SDM was measured with 7 items addressing the 4 components of SDM. The main exposures were (1) the mean level of SDM across the 2 study years and (2) the change in SDM over the 2 years. Using linear regression, we measured the association of SDM and behavioral impairment. Results Among 2,454 subjects representing 10.2 million CSHCN, SDM increased among 37% of the population, decreased among 36% and remained unchanged among 27%. For CSHCN impaired at baseline, the change in SDM was significant with each 1-point increase in SDM over time associated with a 2-point decrease in impairment (95% CI: 0.5, 3.4), whereas the mean level of SDM was not associated with impairment. In contrast, among those below the impairment threshold, the mean level of SDM was significant with each one point increase in the mean level of SDM associated with a 1.1-point decrease in impairment (0.4, 1.7), but the change was not associated with impairment. Conclusion Although the change in SDM may be more important for children with behavioral impairment and the mean level over time for those below the impairment threshold, results suggest that both the change in SDM and the mean level may impact behavioral health for CSHCN.
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Affiliation(s)
- Alexander G Fiks
- The Pediatric Research Consortium (PeRC), The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Abstract
OBJECTIVE : To examine what contributes to resiliency in children living with Duchenne muscular dystrophy (DMD), a chronic, progressive neuromuscular disorder that also influences cognitive ability. The authors hypothesized that family and social support will moderate the effects of individual symptoms of illness severity and influence positive adjustment in boys with DMD. METHOD : One hundred forty-six boys with DMD were included. Child adjustment, as determined by parent ratings of their son's behavior using the Total Behavior score from the Child Behavior Checklist (CBCL), was examined as an outcome measure. The contributions of individual variables (including age [which serves also as a proxy for degree of physical disability], wheelchair use, and estimated verbal IQ), family variables (the Parental Distress score from the Parent Stress Index), and social environment variables (the Social Competence score from the CBCL) on child adjustment were examined in a linear regression analysis. RESULTS : Both family and social environment variables significantly contributed to the variance in the CBCL Total Behavior score. In contrast, individual factors that are related to illness severity (age, degree of physical involvement, and estimated verbal IQ) were not associated with child adjustment. CONCLUSION : Increased children's social networks and decreased parents' stress levels positively contributed to good child adjustment, whereas degree of individual clinical severity did not. Thus, emphasis on providing opportunities for friendships and social support and on parents' adjustment will aid in children's resilience, ensuring they can live well, even while living with the significant burdens associated with DMD.
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Medical and Psychiatric Comorbidities in Children and Adolescents: A Guide to Issues and Treatment Approaches. Nurs Clin North Am 2010; 45:541-54, v. [DOI: 10.1016/j.cnur.2010.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fiks AG, Localio AR, Alessandrini EA, Asch DA, Guevara JP. Shared decision-making in pediatrics: a national perspective. Pediatrics 2010; 126:306-14. [PMID: 20624804 PMCID: PMC3373306 DOI: 10.1542/peds.2010-0526] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify patterns of shared decision-making (SDM) among a nationally representative sample of US children with attention-deficit/hyperactivity disorder (ADHD) or asthma and determine if demographics, health status, or access to care are associated with SDM. PATIENTS AND METHODS We performed a cross-sectional study of the 2002-2006 Medical Expenditure Panel Survey, which represents 2 million children with ADHD and 4 million children with asthma. The outcome, high SDM, was defined by using latent class models based on 7 Medical Expenditure Panel Survey items addressing aspects of SDM. We entered factors potentially associated with SDM into logistic regression models with high SDM as the outcome. Marginal standardization then described the standardized proportion of children's households with high SDM for each factor. RESULTS For both ADHD and asthma, 65% of children's households had high SDM. Those who reported poor general health for their children were 13% less likely to have high SDM for ADHD (64 vs 77%) and 8% less likely for asthma (62 vs 70%) when adjusting for other factors. Results for behavioral impairment were similar. Respondent demographic characteristics were not associated with SDM. Those with difficulty contacting their clinician by telephone were 26% (ADHD: 55 vs 81%) and 29% (asthma: 48 vs 77%) less likely to have high SDM than those without difficulty. CONCLUSIONS These findings indicate that households of children who report greater impairment or difficulty contacting their clinician by telephone are less likely to fully participate in SDM. Future research should examine how strategies to foster ongoing communication between families and clinicians affect SDM.
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Affiliation(s)
- Alexander G. Fiks
- Pediatric Research Consortium, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Generalist Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania,Center for Biomedical Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A. Russell Localio
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Evaline A. Alessandrini
- Divisions of Health Policy and Clinical Effectiveness and Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - David A. Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - James P. Guevara
- Pediatric Research Consortium, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Generalist Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Abstract
The goals of this study were to evaluate the feasibility of depression and anxiety screening in on-therapy adolescents with cancer, determine the prevalence of depression and anxiety in this sample, and assess the concordance between patient and oncologist report of patient symptoms. Forty-one adolescents (ages 12 to 18 y) undergoing cancer therapy in an outpatient oncology clinic completed the Beck Youth Inventory II (BYI II) Depression and Anxiety scales. Treating oncologists independently rated patient depression and anxiety. Ninety-eight percent of patients agreed to participate and average time to measure completion was <15 minutes. Mean T-scores for the BDI-Y (Depression module) and BAI-Y (Anxiety module) for most were not different than published norms. Three and 2 patients scored in the moderate-extremely elevated range of the BAI-Y and BDI-Y, respectively. There were no associations between scores and sex, age, diagnosis, time since diagnosis, or treatment intensity. A depression and anxiety-screening program is feasible in the outpatient pediatric oncology setting. Rates of adolescent self-reported anxiety and depression are low, although oncologists perceived more patient distress. This is an area for future investigation.
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Nisell M, Igl W, Öjmyr-Joelsson M, Frenckner B, Rydelius PA, Christensson K. Social Issues Among Children With High or Intermediate Imperforate Anus: A Proxy Perspective. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2009; 22:132-42. [DOI: 10.1111/j.1744-6171.2009.00179.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Conrad AL, Altmaier EM. Specialized Summer Camp for Children with Cancer: Social Support and Adjustment. J Pediatr Oncol Nurs 2009; 26:150-7. [DOI: 10.1177/1043454209334418] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to assess the types of social support received by children attending a week-long residential summer camp for children with cancer. Following the camp, families were sent a social support questionnaire (for the child to complete) and the Child Behavior Checklist (for parents to complete). Analyses evaluated children's adjustment rated by parents, support reported by children, and the relationship between adjustment and support. Girls reported receiving more support than boys, and both genders reported receiving more support at camp than children in the general population. Ratings of adjustment were not different from normative data for boys or girls. No relationship was found between adjustment and support. The camp environment is very supportive and may offer forms of support not available in other environments. Research is needed to further understand how camp can be supportive, what factors may affect that support, and how the experience enhances children's quality of life.
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Affiliation(s)
| | - Elizabeth M. Altmaier
- College of Education, Psychological & Quantitative Foundations, University of Iowa, Iowa City
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Amouroux R, Rousseau-Salvador C. Anxiété et dépression chez l’enfant et l’adolescent migraineux : revue de la littérature. Encephale 2008; 34:504-10. [DOI: 10.1016/j.encep.2007.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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Warnick EM, Bracken MB, Kasl S. Screening Efficiency of the Child Behavior Checklist and Strengths and Difficulties Questionnaire: A Systematic Review. Child Adolesc Ment Health 2008; 13:140-147. [PMID: 32847173 DOI: 10.1111/j.1475-3588.2007.00461.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Assess the screening efficiency of the caretaker-report CBCL and SDQ in community and clinical samples using published data. METHODS PyschInfo, Medline, and EMBASE were systematically searched to identify studies with appropriate efficiency data. Estimates of sensitivity and specificity were extracted from identified studies and used to generate summary likelihood ratio estimates on which the scales were compared. Summary estimates of sensitivity and specificity were calculated with respect to a 'true' diagnosis to compare scales. RESULTS A total of 29 and 3 studies met inclusion criteria for CBCL and SDQ respectively. Summary estimates of the likelihood ratios for domains assessed by CBCL ranged from 3.86 (2.23, 6.69) to 4.87 (2.90, 8.18); and for SDQ from 5.02 (1.61, 15.63) to 8.32 (2.72, 25.48). Heterogeneity was low. For total problems, the SDQ caretaker-report was found to be most specific (0.93, 95% CI 0.92, 0.94) and the CBCL caretaker-report to be most sensitive (0.66, 95%CI 0.60, 0.73). CONCLUSIONS This meta-analysis supports continued use of the CBCL and SDQ via caretaker-report in clinical and community samples. Additional research is required to determine if there is a true difference in efficiency between the two scales.
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Affiliation(s)
- Erin M Warnick
- Department of Epidemiology and Public Health, Yale University, USA. E-mail: .,Child Study Center, Yale University, USA
| | - Michael B Bracken
- Department of Epidemiology and Public Health, Yale University, USA. E-mail: .,Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University, USA
| | - Stanislav Kasl
- Department of Epidemiology and Public Health, Yale University, USA. E-mail:
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Allison Bender H, Auciello D, Morrison CE, MacAllister WS, Zaroff CM. Comparing the convergent validity and clinical utility of the Behavior Assessment System for Children-Parent Rating Scales and Child Behavior Checklist in children with epilepsy. Epilepsy Behav 2008; 13:237-42. [PMID: 18448391 DOI: 10.1016/j.yebeh.2008.03.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/08/2008] [Accepted: 03/18/2008] [Indexed: 11/25/2022]
Abstract
The convergent validity and clinical utility of two parent-report child behavior rating scales, the Behavior Assessment System for Children-Parent Rating Scales (BASC-PRS) and Child Behavior Checklist/Ages 6-18 (CBCL), in children with epilepsy were examined. Analogous broadband and narrowband behavior rating scales were evaluated in 60 subjects aged 6-17 years (mean=11.0, SD=3.4) with Full Scale IQ >70. Correlations for each similarly labeled scale were statistically significant (P<0.002) and greater with broadband (r=0.71-0.79) than with narrowband (r=0.41-0.78) scales. The BASC captured significantly less composite internalizing symptoms (P<0.002), but more unusual thought processes (P<0.0002) and attention problems versus a CBCL DSM-oriented attention-deficit/hyperactivity disorder scale (P<0.002). Variation in the correlations between measures may stem from underlying differences between rationally-and empirically-derived approaches to test construction. Both the CBCL and BASC have diagnostic and clinical utility in assessing behavior problems in pediatric epilepsy.
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Affiliation(s)
- H Allison Bender
- Comprehensive Epilepsy Center, Department of Neurology, New York University Medical Center, 403 East 34th Street, 4th Floor, New York, NY 10016, USA.
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Olsson GM, Mårild S, Alm J, Brodin U, Rydelius PA, Marcus C. The Adolescent Adjustment Profile (AAP) in comparisons of patients with obesity, phenylketonuria or neurobehavioural disorders. Nord J Psychiatry 2008; 62:66-76. [PMID: 18389428 DOI: 10.1080/08039480801979586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents' socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases.
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Abstract
This review of depressive symptoms in pediatric cancer patients describes the challenge of recognizing depression in this group, prevalence, risk factors, and treatment, primarily with the selective serotonin reuptake inhibitors (SSRIs). Pediatric oncologists prescribe SSRIs, but there is limited data regarding their use in this setting. Adverse effects, pharmacokinetics and metabolism of SSRIs are reviewed to provide a reference for physicians and inform choices for SSRI prescription. Ongoing research includes incorporation of routine screening measures for depression and future studies might focus on physician recognition and prospectively evaluating treatment for children with cancer and depressive symptoms.
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Affiliation(s)
- Leslie S Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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Abstract
A significant component of palliative care is the prompt diagnosis and management of distress, anxiety, and depression. This article reviews the symptoms and treatment of anxiety and depressive disorders in children at the end of life. Distinguishing between symptoms and disorders, the importance of open communication, consideration of the child's understanding of death, diagnostic challenges in chronically ill children, and suicidality are discussed. Because treatment options are available, it is imperative that symptoms are recognized and addressed. Understanding the issues involved in screening and diagnosis and the risks and benefits of available treatments can lead to an informed approach to the management of these disorders in the palliative care setting.
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Affiliation(s)
- Leslie S Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, 4th Floor Wood Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Hendriksen JGM, Poysky JT, Schrans DGM, Schouten EGW, Aldenkamp AP, Vles JSH. Psychosocial Adjustment in Males with Duchenne Muscular Dystrophy: Psychometric Properties and Clinical Utility of a Parent-report Questionnaire. J Pediatr Psychol 2007; 34:69-78. [DOI: 10.1093/jpepsy/jsn067] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hysing M, Elgen I, Gillberg C, Lie SA, Lundervold AJ. Chronic physical illness and mental health in children. Results from a large-scale population study. J Child Psychol Psychiatry 2007; 48:785-92. [PMID: 17683450 DOI: 10.1111/j.1469-7610.2007.01755.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the sensitivity and specificity of the Strengths and Difficulties Questionnaire (SDQ) in detecting emotional and behavioural problems among children with chronic illness (CI). METHODS Parents and teachers of a population of primary school children in Norway (n = 9430) completed a questionnaire including the SDQ, and a question about chronic illness. A total of 74% (n = 7007) of the parents participated. A sub-sample (n = 1040) was given a psychiatric diagnostic evaluation according to the Development and Well-Being Assessment (DAWBA). RESULTS According to parent reports, 537 (8%) children had a CI. The SDQ revealed an increased risk of emotional and behavioural problems in children with CI as compared with non-CI peers, both among boys (OR = 2.10 CI 95% 1.56-2.83) and girls (OR = 2.11 CI 95% 1.49-2.99). Children with CI also showed an increased risk of psychiatric disorder as assessed by the DAWBA (OR = 1.70 CI 95% 1.04-2.85). Both the sensitivity and specificity of the SDQ in predicting a psychiatric diagnosis were high, even when only information from parents was included. CONCLUSION Children with CI in the general population are at increased risk of behavioural and emotional problems and psychiatric disorders. Given its high sensitivity and specificity the SDQ might work well as a screening instrument for behaviour/emotional problems and psychiatric disorder in children with CI.
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Affiliation(s)
- Mari Hysing
- Department of Biological and Medical Psychology, Neuropsychological phenotyping group, University of Bergen, Norway.
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Abstract
Duchenne muscular dystrophy (DMD) is a chronic, progressive pediatric disease that affects both muscle and brain. The objectives of the study were to examine parent reported behavior in children with DMD, investigate the influence of chronic illness, intellectual ability and etiology on behavior, and determine whether a specific behavioral profile is associated with DMD. Parental ratings of boys with DMD (n = 181) on the Child Behavior Checklist behavior scales were examined and compared to reported findings of children with other chronic illnesses, unaffected siblings of boys with DMD (n = 86), and children with cerebral palsy (CP) (n = 42). Increased ratings of general behavior problems were reported, and neither physical progression nor intellectual level contributed to behavioral ratings. Among the children with DMD, the Social Problem behavior scale had the greatest number of "clinically significant" ratings (34%). Between-group comparisons showed significantly more boys with DMD were rated as having social behavior problems than either the sibling or CP comparison groups. In addition to the increase in reported behavioral problems likely related to the effects of chronic illness, boys with DMD may be at heightened risk for specific social behavior problems. The specificity of the findings of the behavior profile in DMD may be partially due to the lack of dystrophin isoforms in the central nervous system, and not solely a reactive response to the illness.
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Affiliation(s)
- Veronica J Hinton
- Gertrude H. Sergievsky Center and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Shemesh E, Yehuda R, Rockmore L, Shneider BL, Emre S, Bartell AS, Schmeidler J, Annunziato RA, Stuber ML, Newcorn JH. Assessment of depression in medically ill children presenting to pediatric specialty clinics. J Am Acad Child Adolesc Psychiatry 2005; 44:1249-57. [PMID: 16292116 DOI: 10.1097/01.chi.0000181043.29208.a2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Self-report measures of depression may be inaccurate when applied to medically ill children because of the overlap between medical and psychiatric symptoms. The American Academy of Pediatrics endorses the use of self-reports as diagnostic aids (used in patients who are suspected of having an emotional problem by their pediatricians). This approach has not been validated. We evaluated the diagnostic accuracy of the Children's Depression Inventory (CDI) in medically ill children who were referred for evaluation by their pediatricians. METHOD The evaluation included the CDI and a best estimate diagnostic procedure that incorporated results from semistructured and other interviews. Evaluators were not aware of the CDI scores when making a diagnostic determination. RESULTS One hundred twenty-five patients, 8-19 years old, were referred between September 2000 and May 2003. Eighty-one completed the diagnostic procedure. The CDI summary score performed well in identifying best estimate depressive disorder determinations in this cohort. A cutoff of 11 and above correctly identified 80% of cases, with a specificity of 70%. DISCUSSION A self-report measure of depression (CDI) could be used as a diagnostic aid in medically ill children who are suspected of having an emotional problem by their pediatricians. This finding supports the "two-tier" depression screening approach endorsed by the American Academy of Pediatrics for use in pediatricians' offices.
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Affiliation(s)
- Eyal Shemesh
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, NY 10029, USA.
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Caplan R, Siddarth P, Gurbani S, Hanson R, Sankar R, Shields WD. Depression and Anxiety Disorders in Pediatric Epilepsy. Epilepsia 2005; 46:720-30. [PMID: 15857439 DOI: 10.1111/j.1528-1167.2005.43604.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This study examined affective disorders, anxiety disorders, and suicidality in children with epilepsy and their association with seizure-related, cognitive, linguistic, family history, social competence, and demographic variables. METHODS A structured psychiatric interview, mood self-report scales, as well as cognitive and language testing were administered to 100 children with complex partial seizures (CPSs), 71 children with childhood absence epilepsy (CAE), and 93 normal children, aged 5 to 16 years. Parents provided behavioral information on each child through a structured psychiatric interview and behavior checklist. RESULTS Significantly more patients had affective and anxiety disorder diagnoses (33%) as well as suicidal ideation (20%) than did the normal group, but none had made a suicide attempt. Anxiety disorder was the most frequent diagnosis among the patients with a diagnosis of affective or anxiety disorders, and combined affective/anxiety and disruptive disorder diagnoses, in those with suicidal ideation. Only 33% received some form of mental health service. Age, verbal IQ, school problems, and seizure type were related to the presence of a diagnosis of affective or anxiety disorder, and duration of illness, to suicidal ideation. CONCLUSIONS These findings together with the high rate of unmet mental health underscore the importance of early detection and treatment of anxiety disorders and suicidal ideation children with CPSs and CAE.
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Affiliation(s)
- Rochelle Caplan
- Department of Psychiatry, University of California at Los Angeles, 90024, USA.
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Winters NC, Collett BR, Myers KM. Ten-year review of rating scales, VII: scales assessing functional impairment. J Am Acad Child Adolesc Psychiatry 2005; 44:309-38; discussion 339-42. [PMID: 15782079 DOI: 10.1097/01.chi.0000153230.57344.cd] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This is the seventh in a series of 10-year reviews of rating scales. Here the authors present scales measuring functional impairment, a sequela of mental illness. The measurement of functional impairment has assumed importance with the recognition that symptom resolution does not necessarily correlate with functional improvement. METHOD The authors reviewed functional impairment from multiple sources over the past 20 years. Thus, this article includes a variety of scales ranging from those that have been subject to critical review with strong psychometric support to those that have not been critically reviewed but are in widespread use to those that are still finding their niche. RESULTS These scales represent a continuum of constructs from symptoms to functional impairment to contextual factors that affect youths' functioning. Most older scales have focused on developmentally delayed youths. Newer scales strive to measure functional impairment separate from symptomatology. Some newer scales are also keyed to determination of level of service need. CONCLUSIONS Scales measuring functional impairment can elucidate the impact of illness on youths, identify targets for treatment, determine service needs, and monitor treatment effectiveness. These scales are widely used in community mental health and health service delivery. They can assist in providing evidence-based treatment.
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Borge AIH, Wefring KW, Lie KK, Nordhagen R. Chronic illness and aggressive behaviour: A population-based study of 4-year-olds. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2004. [DOI: 10.1080/17405620344000004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Witt WP, Kasper JD, Riley AW. Mental health services use among school-aged children with disabilities: the role of sociodemographics, functional limitations, family burdens, and care coordination. Health Serv Res 2004; 38:1441-66. [PMID: 14727782 PMCID: PMC1360958 DOI: 10.1111/j.1475-6773.2003.00187.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the use of mental health services and correlates of receiving services among community-dwelling children with disabilities, ages 6 to 17 years. STUDY DESIGN Data are from the 1994 and 1995 National Health Interview Survey Disability Supplements (NHIS-D), conducted by the National Center for Health Statistics. The study sample is 4,939 children with disabilities, representing an estimated eight million children with disabilities nationwide. Parents of children under 16 years of age reported (17-year-olds self-reported) on health, emotional and behavioral problems, mental health services use, and who, if anyone, coordinated the child's health care. PRINCIPAL FINDINGS Among disabled children with poor psychosocial adjustment (11.5 percent), only 11.8 percent received mental health services in the past year. Multivariate logistic regression analysis showed service use was associated with poor psychosocial adjustment; communication, social, and learning-related functional impairments; public health insurance; and financial family burdens. Younger and black disabled children were less likely to receive mental health services. The odds of service use were greater with the involvement of a health professional in coordinating care, in contrast to no one or family only. Moreover, children with disabilities were more likely to use outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings. CONCLUSIONS Findings indicate that only two in five disabled children with poor psychosocial adjustment receive mental health services. Differences by age, race, and insurance coverage suggest that inequalities to access exist. However, the school setting may be one in which some barriers to mental health services for disabled children are reduced. The study also shows that the involvement of health professionals in care coordination is associated with greater access to mental health care for disabled children. These findings underscore the importance of engaging both health care professionals and the family in the care process.
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Affiliation(s)
- Whitney P Witt
- Center for Healthcare Studies, Northwestern University, Chicago, IL 60611, USA
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Carpentieri SC, Meyer EA, Delaney BL, Victoria ML, Gannon BK, Doyle JM, Kieran MW. Psychosocial and behavioral functioning among pediatric brain tumor survivors. J Neurooncol 2003; 63:279-87. [PMID: 12892234 DOI: 10.1023/a:1024203323830] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe the psychosocial and behavioral functioning, as described by patient, parent and teacher, of a cohort of adolescents who have been previously treated for a brain tumor. METHODS A cohort of 32 patients, 12-18 years old, were evaluated between 1 and 5 years post-treatment for brain tumor during the patient's regularly scheduled follow-up clinic appointment at the Dana-Farber Cancer Institute. The Self-Report questionnaire and the Parent-Report of the Behavioral Assessment System for Children (BASC) were administered to the patient and to one of the patient's parents, respectively. In addition, the BASC Teacher-Report was completed by the patient's teacher. Descriptive statistics were generated; binomial distribution analyses were carried out to assess whether the proportion of individuals with impaired performance on each measure exceeded normative expectations. RESULTS Comparison of the proportion of patients with elevated scores to normative expectations indicated no excess of elevated scores on any of the BASC scales of the Self-Report. However, parents endorsed items in the areas of attention problems and leadership; teachers endorsed items concerning learning problems; and both parents and teachers endorsed items indicative of somatization behaviors. CONCLUSIONS Parent and teacher feedback indicate some level of psychosocial and behavioral morbidity for adolescents treated for a brain tumor; this finding contrasts with adolescent Self-Report indicating no difficulties in behavioral and psychosocial functioning. The extent to which these vulnerabilities impact quality of life and the discrepancy between reporters should be assessed in follow-up studies with a larger cohort of patients.
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Rosina R, Crisp J, Steinbeck K. Treatment adherence of youth and young adults with and without a chronic illness. Nurs Health Sci 2003; 5:139-47. [PMID: 12709169 DOI: 10.1046/j.1442-2018.2003.00149.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence and concerns about living with their illness. A small correlational study was undertaken to compare the psychosocial functioning of young people, with and without chronic illness, aged between 12 and 24 years. Subjects were recruited from a metropolitan teaching hospital. Group 1 included 44 young people with chronic illness; Group 2 included 41 young people without chronic illness. Both groups were divided on the basis of age: younger (12-18 years, n = 24); older (19-24 years, n = 61) and sex (female = 43; male = 42). Subjects completed the Achenbach self-report questionnaire as a measure of psychosocial functioning, and a second questionnaire constructed for this study to explore treatment adherence. Psychosocial functioning scores were found to be similar on the majority of subscales. Young women with chronic illness were, however, found to have significantly higher internalizing scores than young women without chronic illness. A significant negative relationship was found for the chronic illness group between internalizing scores and treatment adherence. The findings highlight potential areas of difficulty in psychosocial functioning of some young people with chronic illness. They also suggest the existence of a subgroup of young people with chronic illness who experience more problems than their peers. More research is needed to generate evidence about this possible subgroup to determine predictors of psychosocial functioning and test the timing and efficacy of psychosocial interventions.
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Affiliation(s)
- Robyn Rosina
- Child and Adolescent Psychological Outreach Service-Telenursing, Department of Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001 Westmead, New South Wales 2145, Australia.
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Yasnovsky J, Araujo K, King M, Mason M, Pavelski R, Shaw R, Steiner H. Defenses in school age children: children's versus parents' report. Child Psychiatry Hum Dev 2003; 33:307-23. [PMID: 12723903 DOI: 10.1023/a:1023088313470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We tested a questionnaire assessing defenses in school age children and compared the results with their mothers' reports of the same. Thirty-four children (56% male, mean age 8.5) completed the Response Evaluation Measure for Youth (REM-Y) twice over three weeks. Simultaneously, mothers completed the parent version of this measure (REM-P) about their children. In these questionnaires, factor 1 defenses (less adaptive; broken down into intrapersonal and interpersonal defenses) are assessed separately from factor 2, or more adaptive, defenses. Only lower level, interpersonal defenses, such as acting out, were recognized by mothers in their children. The children's intrapersonal defenses, along with factor 2 reactions, were reported less by mothers than by children.
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Abstract
The consequences of depression in medically ill children include the disability and morbidity that is associated with depression in any patient. They also include an exacerbation of the underlying medical disease and nonadherence to treatment. Thus, medically ill children who are depressed constitute a special, high-risk group of patients who may suffer from severe consequences above and beyond those that are expected in a medically sound population. This manuscript reviews methodologic and practical difficulties that are associated with the diagnosis and treatment of depression in this group of patients. Because treatment of depression in medically ill children may well lead to improvement in medical and psychiatric outcome, there is pressing need for the careful study of potential treatment options in this specific group of patients.
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Affiliation(s)
- Eyal Shemesh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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Ott D, Caplan R, Guthrie D, Siddarth P, Komo S, Shields WD, Sankar R, Kornblum H, Chayasirisobhon S. Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence. J Am Acad Child Adolesc Psychiatry 2001; 40:907-14. [PMID: 11501690 DOI: 10.1097/00004583-200108000-00012] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This investigation examined psychopathology in 48 children with complex partial seizures (CPS), 39 children with primary generalized epilepsy with absence (PGE), and 59 nonepileptic children, aged 5 to 16 years, by comparing the Child Behavior Checklist (CBCL) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). METHOD The CBCL was completed by parents and the K-SADS was administered to both parent and child. RESULTS The CBCL identified psychopathology in 26% and the K-SADS in 51% of the CPS and PGE patients (kappa = 0.32). The CPS and PGE groups had significantly higher mean CBCL scores, as well as higher rates of psychiatric diagnoses and symptoms of psychopathology, compared with the nonepileptic group. However, the CPS and PGE groups did not differ in these measures. Within each patient group, Full Scale IQ, but not seizure control, was associated with these measures of psychopathology. CONCLUSION These findings suggest that the K-SADS identifies more children with psychopathology than the CBCL in children with CPS and PGE.
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Affiliation(s)
- D Ott
- Neuropsychiatric Institute, Los Angeles, CA, 90024, USA.
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Erickson SJ, Steiner H. Trauma spectrum adaptation: somatic symptoms in long-term pediatric cancer survivors. PSYCHOSOMATICS 2000; 41:339-46. [PMID: 10906356 DOI: 10.1176/appi.psy.41.4.339] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors assessed somatic symptoms and the degree of association among somatic symptoms, global adjustment, trauma symptoms, and personality characteristics in long-term pediatric cancer survivors. Forty cancer survivors completed self-report questionnaires and clinical interviews. Participants' level of somatic symptoms fell between nonclinic and psychiatric populations. Somatic symptom scores correlated with general adjustment in the negative direction and with posttraumatic stress disorder (PTSD) scores in the positive direction. The majority of participants met at least partial current PTSD criteria. Because these survivors demonstrate a repressive adaptive style but endorse somatic symptoms, the latter may represent a method for detecting trauma-related distress in this population.
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Affiliation(s)
- S J Erickson
- Department of Psychology, University of New Mexico, Albuquerque 87131-1161, USA.
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Abstract
Behavioral problems of 116 children with asthma were studied at the Linn Medical Center in Haifa, Israel, where they were under treatment. Parents were administered a medical questionnaire and the Achenbach Child Behavior Checklist. The study examines the relationship between asthmatic children of various levels of severity of the illness and behavioral problems. A comparison was made among the Achenbach scale, level of compliance with treatment procedures, and level of severity of the illness. Another comparison was made between age groups and level of behavioral problems. Significant differences were found between all three illness severity groups and two variables—somatic complaints and social problems. Differences were also found between age groups for the withdrawn variable.
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Knapp PK, Harris ES. Consultation-liaison in child psychiatry: a review of the past 10 years. Part II: Research on treatment approaches and outcomes. J Am Acad Child Adolesc Psychiatry 1998; 37:139-46. [PMID: 9473909 DOI: 10.1097/00004583-199802000-00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To critically review the research and reports on consultation-liaison psychiatry in the past 10 years. METHOD Articles contributing to the conceptualization of child psychiatric consultation in medical, epidemiological, and nonmedical domains were reviewed. RESULTS Information was organized into methodology and treatment outcome categories. Nonmedical consultation articles were briefly reviewed. Articles reporting therapeutic techniques in consultation-liaison work and outcome studies are described. CONCLUSIONS In spite of constraints imposed by managed care upon referral to specialists, the current epoch finds child psychiatrists both better equipped and more compelled to use their skills in innovative ways to help children in different domains.
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Affiliation(s)
- P K Knapp
- Department of Psychiatry and Pediatrics, University of California Davis, USA
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Knapp PK, Harris ES. Consultation-liaison in child psychiatry: a review of the past 10 years. Part I: Clinical findings. J Am Acad Child Adolesc Psychiatry 1998; 37:17-25. [PMID: 9444895 DOI: 10.1097/00004583-199801000-00012] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To critically review clinical reports on pediatric consultation-liaison psychiatry over the past 10 years. METHOD Articles contributing to the understanding of child psychiatric consultation in medical settings were reviewed. RESULTS Information related to clinical issues was organized into categorical (disease-oriented), noncategorical, and family studies. Newer articles on ethical considerations in caring for medically ill children are summarized. CONCLUSIONS Research has continued to focus on and reflect the importance of the emotional and behavioral needs of children in pediatric settings and the adaptation and stress within families who care for chronically ill children. Given the increased complexity and demands of medical care, the training and skills of a child psychiatrist in pediatric consultation remain a valuable component of comprehensive care for children.
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Affiliation(s)
- P K Knapp
- Department of Psychiatry and Pediatrics, University of California, Davis, USA
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