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Karlson CW, Barajas KG, Erp LS, Winston K. Psychosocial Assessment Tool 2.0 and Long-Term Mental Health Outcomes in Childhood Cancer. J Pediatr Hematol Oncol 2024:00043426-990000000-00473. [PMID: 39120592 DOI: 10.1097/mph.0000000000002935] [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] [Received: 12/28/2023] [Accepted: 07/02/2024] [Indexed: 08/10/2024]
Abstract
To identify childhood cancer patients and their families at the greatest risk for psychosocial difficulties, this study examined the predictive validity of the Psychosocial Assessment Tool 2.0 (PAT2.0) on caregiver and patient-reported mental health outcomes at 1-year follow-up. The PAT2.0 was administered to caregivers a median of 0.08 years after cancer diagnosis. A brief psychosocial screening battery (Family Symptom Inventory and PROMIS v1.0 Pediatric Profile-25) was administered to patient-caregiver dyads (n=53) ∼1-year later. Linear regressions support the longitudinal predictive validity of the PAT2.0 for caregiver-reported child and caregiver mental health symptoms and child-reported peer relationships difficulties.
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Affiliation(s)
- Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Kimberly G Barajas
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Lauren S Erp
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Kaysie Winston
- Division of Hematology/Oncology, Department of Pediatrics
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2
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Beveridge JK, Noel M, Soltani S, Neville A, Orr SL, Madigan S, Birnie KA. The association between parent mental health and pediatric chronic pain: a systematic review and meta-analysis. Pain 2024; 165:997-1012. [PMID: 38112571 DOI: 10.1097/j.pain.0000000000003125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Mental health problems are common among parents of children with chronic pain and associated with worse outcomes for the child with chronic pain. However, the effect sizes of these associations between parent mental health and pediatric chronic pain vary widely across studies. The aim of this systematic review and meta-analysis was to generate pooled estimates of the (1) prevalence of mental health problems among parents of children with chronic pain and (2) associations between parent mental health and the (2a) presence of child chronic pain and (2b) functioning of children with chronic pain. Embase, MEDLINE, PsycINFO, Web of Science, and CINAHL were searched up to November 2022. Observational studies that examined symptoms or diagnoses of parent anxiety, depression, or general distress and the presence of child chronic pain and/or related functioning were included. From 32,848 records, 2 coders identified 49 studies to include in random-effects meta-analyses. The results revealed that mental health problems among parents of children with chronic pain were common (anxiety: 28.8% [95% CI 20.3-39.1]; depression: 20.0% [15.7-25.2]; general distress: 32.4% [22.7-44.0]). Poorer parent mental health was significantly associated with the presence of chronic pain (anxiety: OR = 1.91 [1.51-2.41]; depression: OR = 1.90 [1.51-2.38]; general distress: OR = 1.74 [1.47-2.05]) and worse related functioning (ie, pain intensity, physical functioning, anxiety and depression symptoms; r s = 0.10-0.25, all P s < 0.05) in children. Moderator analyses were generally nonsignificant or could not be conducted because of insufficient data. Findings support the importance of addressing parent mental health in the prevention and treatment of pediatric chronic pain.
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Affiliation(s)
- Jaimie K Beveridge
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexandra Neville
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Serena L Orr
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Departments of Community Health Sciences
- Pediatrics and Clinical Neurosciences, and
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Kathryn A Birnie
- Department of Psychology, University of Calgary, Calgary, AB, Canada. Neville is now with the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Departments of Community Health Sciences
- Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, AB, Canada
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3
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Kazak A, Ramirez AP, Scialla MA, Alderfer MA, Sewell-Roberts C, Treadwell-Deering D. Adaptation and pilot implementation of the Psychosocial Assessment Tool for Autism Spectrum Disorders (PAT-ASD). J Autism Dev Disord 2023; 53:4308-4317. [PMID: 36001195 PMCID: PMC9399998 DOI: 10.1007/s10803-022-05713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Recognizing the multifaceted and chronic demands on families of children with Autism Spectrum Disorder (ASD) and challenges in providing care matched to need, we adapted the Psychosocial Assessment Tool (PAT), a brief caregiver-report screener of family psychosocial risk, for this population. Study methods included literature review, focus groups with providers, and feedback from caregivers. The PAT-ASD is consistent with the original PAT, with new items reflecting core behavioral manifestations of ASD and parent and family challenges associated with chronicity. The PAT-ASD was implemented in a four-month pilot and was completed online by 59% of families. Although further testing of its validity is necessary, the PAT-ASD is a promising means of assessing family psychosocial risk for families of children with ASD.
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Affiliation(s)
- Anne Kazak
- Nemours Children's Health, Wilmington, DE, United States.
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States.
| | | | | | - Melissa A Alderfer
- Nemours Children's Health, Wilmington, DE, United States
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Diane Treadwell-Deering
- Nemours Children's Health, Wilmington, DE, United States
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States
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4
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Hocking P, Broadhurst M, Nixon RDV, Gannoni A. Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients. Burns 2023; 49:1632-1642. [PMID: 37211476 DOI: 10.1016/j.burns.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns. METHODS Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn. RESULTS The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively. CONCLUSION The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.
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Affiliation(s)
- Phoebe Hocking
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Miriam Broadhurst
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia; Flinders University Institute for Mental Health and Wellbeing, Flinders University; Adelaide, South Australia, Australia.
| | - Anne Gannoni
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Enlow PT, Lewis AM, Scialla MA, Hwang WT, Kazak AE. Validating the Factor Structure of the Psychosocial Assessment Tool Using Internet-Based Data. J Pediatr Psychol 2022; 47:215-224. [PMID: 35026020 DOI: 10.1093/jpepsy/jsab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Psychosocial Assessment Tool (PAT) is a well-validated, brief screener of family psychosocial risk. Since 2014 a web-based version of the PAT (WebPAT) has been available for use by clinicians and researchers, but the psychometric properties have not been examined. The objective of this article was to examine the factor structure and internal consistency of the WebPAT, which was administered to caregivers of youth with cancer. METHODS The WebPAT was administered to 1,252 caregivers of youth with cancer across 29 institutions. Confirmatory factor analysis (CFA) was used to examine the factor structure of the WebPAT. Internal consistencies of the total and subscale scores were examined via the Kuder-Richardson 20 coefficient. The distribution of total PAT score across the three risk categories of the Pediatric Psychosocial Preventative Health Model (PPPHM) was also examined. RESULTS The CFA supported the original seven-factor structure of the PAT (Family Structure, Social Support, Child Problems, Sibling Problems, Family Problems, Stress Reactions, and Family Beliefs). Internal consistencies were strong for the total PAT score and four subscales (Social Support, Child Problems, Sibling Problems, and Family Problems). The distribution of total PAT scores across PPPHM risk categories was consistent with prior research. CONCLUSIONS The WebPAT is a psychometrically sound screener of psychosocial risk in families of youth with cancer. Healthcare providers can use the WebPAT to assess families' psychosocial risk and guide the provision of psychosocial care. Future research should evaluate the implementation of the PAT and identify barriers and facilitators to implementation.
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Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Health, USA
| | - Michele A Scialla
- Center for Healthcare Delivery Science, Nemours Children's Health, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis. Eur J Psychotraumatol 2022; 13:2116825. [PMID: 36186160 PMCID: PMC9518403 DOI: 10.1080/20008066.2022.2116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. OBJECTIVES Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. METHODS Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. RESULTS The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. CONCLUSION Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.,Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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Wesley KL, Hoehn J, Butz C, Aylward SC. Experiences of Pain and Quality of Life in Pediatric Intracranial Hypertension. J Pediatr Psychol 2021; 47:412-419. [PMID: 34875076 DOI: 10.1093/jpepsy/jsab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine psychosocial correlates, specifically pain intensity, pain interference, and quality of life (QOL), in patients with pediatric intracranial hypertension. We hypothesized that parents and children who report higher levels of pain intensity and interference would be associated with lower QOL. METHODS Eighty-three patients and their families seen in the pediatric intracranial hypertension clinic of a large pediatric hospital completed self-report and parent proxy measures on QOL, mood, and other psychosocial correlates. Bivariate correlations were conducted between parent proxy and self-reports and regression analyses between pain and psychosocial correlate variables were examined. RESULTS Parent proxy and child reports were highly correlated. Body mass index (BMI) was a significant predictor of parent proxy report of pain intensity with higher BMI associated with higher parent proxy ratings of pain intensity. Parents reported significantly higher levels of pain interference for their children compared to child report. Parent ratings of child depression symptoms, BMI, and age were significant predictors of pain interference. Higher BMI and depression symptoms and younger age were associated with more pain interference. Overall QOL was similar to other headache populations but lower than other chronic illness and healthy populations. CONCLUSIONS Pediatric intracranial hypertension is associated with decreased QOL. Body mass index was a significant predictor of pain intensity and interference and should be monitored closely in clinic. Clinical care should include psychosocial screening to identify patients who would benefit from interventions to reduce the impact of this condition.
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Affiliation(s)
- Katherine L Wesley
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children's Hospital Colorado, USA
| | - Jessica Hoehn
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, USA
| | - Catherine Butz
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, USA
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, USA
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Vaiman M, Mametov K, Roitblat Y, Abba M, Nehuliaieva L, Foonberg M, Frank C, Kaliberdenko VB, Shterenshis M. Reassessment of Pediatric Tension-Type Headaches. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1721460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractA retrospective multicenter chart review was conducted with the objective of evaluating the hypothesis that certain cases diagnosed as tension-type headache (TTH) in pediatric neurology are not stress-related or central sensitization-related conditions but may mimic an autoimmune disorder of the dura mater. Of the 29,642 patient charts reviewed, 12,424 charts (42%) were excluded because of incomplete data and 17,218 cases were analyzed. For all the 29,642 charts, TTH or chronic daily headaches were diagnosed in 29.2% of cases. Among the 17,218 cases subjected to detailed diagnostic procedures, TTH was diagnosed in only 5%. In 7,044 cases, the initial diagnosis of TTH was changed to headache attributed to infection (87.4%), which was supported by the presence of meningeal signs, high antistreptolysin-O titers, and, in 46% of cases, magnetic resonance imaging (MRI)-detected thickening of the cranial dura mater. The initial diagnosis of migraine was confirmed in 87.7% of cases (8,034/9,162). In some cases of treatment-resistant pediatric recurrent headaches, which are initially diagnosed as TTH, a secondary type of headache may be suspected as the underlying cause. Usually this type of headache has streptococcal infection-related laboratory findings, the meninges as the site of the lesion, and meningism as the clinical presentation.
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Affiliation(s)
- Michael Vaiman
- Department of Otorhinolaryngology, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Kadri Mametov
- Emergency Department, Crimean Republican Center for Disaster Medicine and Emergency Medical Aid, Simferopol, Russia
| | - Yulia Roitblat
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
| | - Michael Abba
- Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Liliia Nehuliaieva
- Department of Pediatrics, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Maya Foonberg
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
- Department of Advanced Research and Design, Milken Community High School, Los Angeles, California, United States
| | - Charles Frank
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
- Department of Advanced Research and Design, Milken Community High School, Los Angeles, California, United States
| | - Vitalii B. Kaliberdenko
- Department of Internal Medicine, V.I. Vernadsky Crimean Federal University, Simferopol, Russia
| | - Michael Shterenshis
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
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Law EF, Zhou C, Seung F, Perry F, Palermo TM. Longitudinal study of early adaptation to the coronavirus disease pandemic among youth with chronic pain and their parents: effects of direct exposures and economic stress. Pain 2021; 162:2132-2144. [PMID: 34050112 PMCID: PMC8205975 DOI: 10.1097/j.pain.0000000000002290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022]
Abstract
ABSTRACT The novel coronavirus disease (COVID-19) has caused prolonged disruptions in daily life for many communities. Little is known about the impact of the COVID-19 pandemic on the health and well-being of youth with chronic pain and their families. We conducted a longitudinal, mixed-methods study to characterize early adaptation to the COVID-19 pandemic among 250 families of youth (ages 12-21 years) diagnosed with chronic headache (64%) or other chronic pain conditions (36%) and to determine whether direct exposures to COVID-19 and secondary economic stress modified symptom trajectories. Youth and parents reported on pain interference, anxiety, depression, and insomnia symptoms at 4 waves of data collection from April 2020 to July 2020. We also collected qualitative data on the impact of the pandemic on the youth's pain problem. Nearly half of our sample (49.6%) experienced direct exposures to COVID-19. Secondary economic stress was also common, affecting 44.4% of families. Symptom trajectories for pain, insomnia, depression, and anxiety remained stable or improved for most participants, indicating adaptive adjustment. However, overall symptom burden was high with persistent and clinically elevated depression, anxiety, and insomnia symptoms common among youth and parents. Direct exposures to COVID-19 did not modify symptom trajectories. However, youth pain interference and parent insomnia worsened in families who experienced secondary economic stress. Qualitative data revealed perceived benefits and harms from school closures on the youth's pain problem. Our findings of high symptom burden suggest that pediatric pain clinicians should offer distance assessment and treatment (eg, through telemedicine) to avoid pandemic-related disruptions in pain care.
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Affiliation(s)
- Emily F. Law
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine
| | - Chuan Zhou
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute
- Department of Pediatrics, University of Washington School of Medicine
| | - Fiona Seung
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute
| | - Frankie Perry
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute
| | - Tonya M. Palermo
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine
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10
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Sinus, disabling tension-type, and temporomandibular joint headaches. Curr Opin Neurol 2021; 34:344-349. [PMID: 33709975 DOI: 10.1097/wco.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Clinicians frequently face questions from headache patients regarding the roles played by sinus issues, muscle tension, and temporomandibular joint (TMJ) problems. This review highlights new concepts regarding the diagnosis and management of these headache conditions and their differentiation from migraine. RECENT FINDINGS Recent research has clarified the roles played by pathology in the paranasal sinuses and TMJ in patients reporting headache. Additional information from physiologic studies in patients with tension-type headache (TTH) has improved the understanding of this condition. SUMMARY Improved understanding of sinus headache, disabling TTH, and TMJ headache and their differentiation from migraine will lead to reductions in unnecessary diagnostic procedures and unwarranted medical and surgical procedures. More expedient recognition of the origin of headache should lead to improved therapeutic outcomes.
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11
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Reader SK, Keeler CN, Chen FF, Ruppe NM, Rash-Ellis DL, Wadman JR, Miller RE, Kazak AE. Psychosocial Screening in Sickle Cell Disease: Validation of the Psychosocial Assessment Tool. J Pediatr Psychol 2021; 45:423-433. [PMID: 32142136 DOI: 10.1093/jpepsy/jsaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Families of youth with Sickle Cell Disease (SCD) can face psychosocial adversity including emotional distress, functional impairments, and sociodemographic risk factors. Systematic screening of psychosocial risk can identify families who may benefit from further assessment and evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief caregiver-report screener based on the tri-level Pediatric Psychosocial Preventative Health Model (PPPHM). METHODS Findings are presented from the baseline assessment of a longitudinal study validating a Sickle Cell version of the PAT 2.0. Primary caregivers of 136 youth with SCD receiving care through a multidisciplinary SCD clinic in a children's hospital completed the PAT and validation measures. A subset of 25 caregivers completed the PAT a second time within 3-5 weeks. RESULTS Internal consistency for the total score was strong (α = .87), and for the subscales was moderate to strong (α = .74-.94), with the exception of the Family Structure (α = .38), Caregiver Beliefs (α = .48), and Stress Reactions (α = .56) subscales. Test-retest reliability was also strong (r = .86, p < .001). Moderate to strong correlations with all except two criteria measures provided validation for the total and subscale scores. Validation measures varied significantly across the three levels of the PPPHM. CONCLUSIONS Results provide support for the reliability and validity of the PAT in SCD. Systematic screening with the PAT can help identify families of youth with SCD at risk for psychosocial problems and potentially help connect them to appropriate services.
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Affiliation(s)
- Steven K Reader
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Sidney Kimmel Medical College, Thomas Jefferson University
| | - Colleen N Keeler
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Fang Fang Chen
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Nicole M Ruppe
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Diana L Rash-Ellis
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Jean R Wadman
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Robin E Miller
- Sidney Kimmel Medical College, Thomas Jefferson University.,Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Sidney Kimmel Medical College, Thomas Jefferson University
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12
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Bromberg MH, de la Vega R, Law EF, Zhou C, Palermo TM. Development and Validation of the Adolescent Insomnia Questionnaire. J Pediatr Psychol 2020; 45:61-71. [PMID: 31584648 DOI: 10.1093/jpepsy/jsz073] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Insomnia is a highly prevalent sleep disorder that is particularly common among adolescents with health conditions. We aimed to develop and validate a brief screening measure of insomnia in adolescents that can be used across clinical and community samples. We hypothesized that we would identify evidence supporting reliability, convergent/discriminant validity, and that we would determine preliminary clinical cutoff scores. METHODS A team of experts in behavioral sleep medicine developed a 13-item brief screening measure of insomnia in adolescents (Adolescent Insomnia Questionnaire [AIQ]). We evaluated the psychometric properties of the AIQ in a sample of 315 youth (11-18 years old, Mean = 14.90, SD = 2.02; 64% female) who had chronic pain (n = 37), headache (n = 170), insomnia diagnosed by a sleep specialist (n = 22), or were otherwise healthy (n = 86). RESULTS Using Exploratory and Confirmatory Factor Analysis, we identified three subscales consistent with major diagnostic criteria of insomnia. As expected, the measure showed strong reliability through high internal consistency (α =.91). We also found strong convergent validity through expected positive relationships between the AIQ and self-report measures of sleep disturbance, and divergent validity via weak relationships with parent-report of snoring. Results of receiver operating characteristic (ROC) identified a clinical cutoff score that may assist in clinical decision making. CONCLUSIONS We found that the AIQ has sound psychometric properties in a large heterogeneous sample of treatment-seeking youth and youth from the community. The AIQ can quickly screen adolescent insomnia and could address an important clinical need in identifying youth in need of insomnia treatment in pediatric practice settings.
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Affiliation(s)
- Maggie H Bromberg
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Rocio de la Vega
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Emily F Law
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute.,Department of Pediatrics, University of Washington, Seattle WA, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
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Law EF, Blume H, Palermo TM. Longitudinal Impact of Parent Factors in Adolescents With Migraine and Tension-Type Headache. Headache 2020; 60:1722-1733. [PMID: 32853406 DOI: 10.1111/head.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine longitudinal associations between parent factors (parent headache frequency and disability, protective parenting behaviors, parent catastrophizing) with adolescent headache-related disability and headache frequency over 6 months. BACKGROUND Theoretical models propose bidirectional, longitudinal relationships between parent factors and adolescent headache. Few studies have examined this using prospective study designs. DESIGN AND METHODS Participants were a cohort of 239 youth ages 11-17 years with recurrent migraine (with and without aura; chronic migraine) or tension-type headache (episodic and chronic) and their parents recruited from a pediatric neurology clinic and the community who completed assessments at baseline and 6-month follow-up. RESULTS After controlling for demographic and clinical covariates, we found that every point increase in baseline protective parenting behavior corresponded with a 2.19-point increase in adolescent headache frequency at follow-up (P = .026, 95% CI [0.27, 4.10]). Similarly, every point increase in baseline parent catastrophizing corresponded with a 0.93-point increase in adolescent headache-related disability (P = .029, 95% CI [0.09, 1.77]) and a .13-point increase in adolescent headache frequency (P = .042, 95% CI [0.01, 0.25]) at follow-up. We also found support for the reverse association, where every point increase in baseline adolescent headache-related disability predicted a 0.03-point increase in parent catastrophizing (P = .016, 95% CI [0.01, 0.05]) and a 0.02-point increase in protective parenting behavior (P = .009, 95% CI [0.01, 0.03]) at follow-up. The remaining bidirectional, longitudinal associations tested between parent factors and adolescent headache were not statistically significant. CONCLUSION Findings suggest that family-based psychological interventions targeting modifiable adolescent and parent factors may lead to improvements in adolescent headache-related disability and reductions in adolescent headache frequency.
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Affiliation(s)
- Emily F Law
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Heidi Blume
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
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14
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Verma R, Mehdian Y, Sheth N, Netten K, Vinette J, Edwards A, Polyviou J, Orkin J, Amin R. Screening for caregiver psychosocial risk in children with medical complexity: a cross-sectional study. BMJ Paediatr Open 2020; 4:e000671. [PMID: 32789196 PMCID: PMC7389766 DOI: 10.1136/bmjpo-2020-000671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To quantify psychosocial risk in family caregivers of children with medical complexity using the Psychosocial Assessment Tool (PAT) and to investigate potential contributing sociodemographic factors. DESIGN Cross-sectional study. SETTING Family caregivers completed questionnaires during long-term ventilation and complex care clinic visits at The Hospital for Sick Children, Toronto, Ontario, Canada. PATIENTS A total of 136 family caregivers of children with medical complexity completed the PAT questionnaires from 30 June 2017 through 23 August 2017. MAIN OUTCOME MEASURES Mean PAT scores in family caregivers of children with medical complexity. Caregivers were stratified as 'Universal' low risk, 'Targeted' intermediate risk or 'Clinical' high risk. The effect of sociodemographic variables on overall PAT scores was also examined using multiple linear regression analysis. Comparisons with previous paediatric studies were made using T-test statistics. RESULTS 136 (103 females (76%)) family caregivers completed the study. Mean PAT score was 1.17 (SD=0.74), indicative of 'Targeted' intermediate risk. Sixty-one (45%) caregivers were classified as Universal risk, 60 (44%) as Targeted risk and 15 (11%) as Clinical risk. Multiple linear regression analysis revealed an overall significant model (p=0.04); however, no particular sociodemographic factor was a significant predictor of total PAT scores. CONCLUSION Family caregivers of children with medical complexity report PAT scores among the highest of all previously studied paediatric populations. These caregivers experience significant psychosocial risk, demonstrated by larger proportions of caregivers in the highest-risk Clinical category.
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Affiliation(s)
- Rahul Verma
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - Yasna Mehdian
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Neel Sheth
- Faculty of Science, Western University, London, Ontario, Canada
| | - Kathy Netten
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jean Vinette
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ashley Edwards
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Polyviou
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Department of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences (CHES) SickKids Research Institute, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences (CHES) SickKids Research Institute, Toronto, Ontario, Canada
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