Impact of COVID-19 Campus Closure on Undergraduates

Background

The COVID-19 pandemic resulted in an abrupt transition from in-person to online learning in Spring 2020.

Objective

The purpose of this study was to identify the impact of the transition on undergraduates during the period following the campus closure.

Method

131 psychology undergraduate students completed an online survey of how the COVID-19 closure had impacted their academics, online learning environment, and traumatic stress symptoms (using the Posttraumatic Stress Disorder Checklist for the DSM-5).

Results

Most participants reported increased academic difficulty compared to before closure. Approximately 30% reported elevated traumatic stress symptoms. Greater traumatic stress was associated with greater difficulty completing assignments, more limited access to the internet and quiet places to study, and greater sibling-care responsibilities.

Conclusions

The acute transition to online instruction posed academic and emotional challenges to many students, especially those from environments with competing demands or less access to academic supports. Follow-up evaluation is needed to determine whether these difficulties have persisted in subsequent semesters of online instruction.

Teaching Implication

Instructors should anticipate the emotional and academic needs of students who are relatively unfamiliar with online instruction and consider ways to minimize negative environmental impacts and increase access to mental health resources.

Conditioned Pain Modulation in Children: The Effects of Painful and Nonpainful Conditioning Stimuli

Conditioned pain modulation (CPM), a psychophysical measure in which 1 pain stimulus (conditioning stimulus) is used to inhibit another pain stimulus (test stimulus), is an important indicator of endogenous pain inhibition in adults, but is understudied in children. Preliminary evidence suggests that CPM effects are present in healthy children and are more robust in adolescents. However, developmental differences in younger children are not well documented and few studies control for potential distraction effects of the conditioning stimulus (CS). Participants were 54 healthy children aged 6 to 12 years. After a baseline pressure pain threshold (PPT) test, participants underwent 2 conditioning trials in which PPT was assessed while they placed their left hand in a water bath maintained at either 12 °C (painful CS) or 22 °C (nonpainful sham CS) in counterbalanced order. Results revealed a significant CPM effect. PPT values were significantly higher relative to baseline during the painful CS trial; PPT during the nonpainful CS trial did not differ from baseline. There were no significant age differences in magnitude of CPM effect. The results indicate that children as young as 6 years of age demonstrate CPM, suggesting that descending inhibitory pathways may be better developed in young children than previously thought. PERSPECTIVE: This study was successful in producing inhibitory CPM effects in physically healthy children while controlling for sensory distraction. The findings provide strong evidence that the obtained CPM responses cannot be attributed to sensory distraction or other nonspecific effects. Future studies could utilize CPM paradigms to study various aspects of pediatric endogenous pain inhibition, in order to better predict pain responses and improve interventions.

Cognitive load and the effectiveness of distraction for acute pain in children

BACKGROUND

Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in some healthy adult samples. We examined the effects of a high-demand 'working memory' 1-back task compared to a low-demand 'motor control' task on pain intensity and unpleasantness ratings in healthy children. Additionally, dispositional mindfulness was examined to explore the mechanisms of distraction on the affective processing of pain.

METHODS

Fifty-seven children (9-13 years old) experienced three randomly presented heat levels (not painful, slightly painful, moderately painful) during two distraction conditions involving different levels of cognitive load (a high load 'working memory' task and a low load 'motor' control task) in counter-balanced order. Children completed measures of dispositional mindfulness, and attentional control and emotional control.

RESULTS

As predicted, children's pain intensity and pain unpleasantness ratings were lower in the high load condition compared to the low load condition. These differences were amplified in the moderately painful heat trials. In contrast with predictions, dispositional mindfulness did not significantly predict the effectiveness of distraction. Dispositional mindfulness was significantly related to measures of children's attentional and emotional control abilities; however, an exploratory serial mediation model did not produce significant indirect or overall effects to suggest a strong influence of mindfulness on the effectiveness of distraction.

CONCLUSIONS

Results demonstrate that distraction that places higher demand on executive resources is more effective for acute pain management for children. Further research is needed to explore cognitive and affective moderators of the effectiveness of distraction for children.

SIGNIFICANCE

This study is one of the first to demonstrate that working-memory engagement can attenuate pain intensity and pain unpleasantness in children aged 9-13. The findings suggest that distraction tasks used in clinical settings for moderately painful medical procedures may benefit more children if they are adequately demanding of cognitive resources.

The Development and Evaluation of a Statewide Training Center for Home Visitors and Supervisors

This paper informs practice in community-based home visiting workforce development by describing the development and evaluation of a university-based training certificate program for home visitors and supervisors. The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008) guides our conceptualization and paper organization. The ISF describes the components involved in translating research findings into effective implementation of prevention programs. We describe implementation and lessons learned from seven development activities: (a) review of the literature, (b) survey of other training initiatives across the country, (c) focus groups with home visitors and supervisors, (d) consultation with individual home visitors, (e) creation of a state advisory board of home visiting providers and stakeholders, (f) evaluation of two pilot trainings, and (g) video development. We then present evaluation data from 49 home visitors and 23 supervisors who completed the training certificate program after the pilot trainings. Both home visitors and supervisors rated training satisfaction highly, reported significant increases in self-efficacy related to the training topics, and reported extensive use of motivational communication techniques, which are the foundational skills of the training content. These and other favorable results reflect the benefits of building on advances in theory and science-based practice and of involving providers and stakeholders repeatedly throughout the development process.

The effects of auditory background noise and virtual reality technology on video game distraction analgesia

Background and aims

The present study was designed to evaluate the relative efficacy of two video game display modalities – virtual reality (VR) assisted video game distraction, in which the game is presented via a VR head-mounted display (HMD) helmet, versus standard video game distraction, in which the game is projected on a television – and to determine whether environmental context (quiet versus noisy) moderates the relative efficacy of the two display modalities in reducing cold pressor pain in healthy college students.

Methods

Undergraduate students (n=164) were stratified by sex and self-reported video game skill and were randomly assigned to a quiet or a noisy environment. Participants then underwent three cold pressor trials consisting of one baseline followed by two distraction trials differing in display modality (i.e. VR-assisted or standard distraction) in counter-balanced order.

Results

Participants experienced improvement in pain tolerance from baseline to distraction in both display modality conditions (p<0.001, partial η2=0.41), and there was a trend toward greater improvement in pain tolerance from baseline to distraction when using the VR HMD helmet than during standard video game distraction (p=0.057, partial η2=0.02). Participants rated pain as more intense when experienced with concurrent experimental background noise (p=0.047, partial η2=0.02). Pain tolerance was not influenced by the presence or absence of background noise, and there was not a significant interaction between display modality and noise condition. Though exploratory sex analyses demonstrated a significant three-way interaction between noise condition, sex, and display modality on pain intensity (p=0.040, partial η2=0.040), follow-up post-hoc analyses conducted for males and females separately did not reveal significant differences in pain intensity based on the interaction between noise condition and display modality.

Conclusions

As expected, video game distraction both with and without an HMD helmet increased pain tolerance; however, the two display modalities only marginally differed in efficacy within the population under study. The effect of auditory background noise on pain was mixed; while pain tolerance did not vary as a function of the presence or absence of background noise, the addition of noise increased pain intensity ratings. The interaction between participant sex, noise condition, and distraction modality on pain intensity trended toward significance but would require replication in future research.

Implications

Results suggest that video game distraction via HMD helmet may be superior to standard video game distraction for increasing pain tolerance, though further research is required to replicate the trending findings observed in this study. Though it does not appear that background noise significantly impacted the relative efficacy of the two different video game display modalities, the presence of noise does appear to alter the pain response through amplified pain intensity ratings. Further research utilizing more sophisticated VR technology and clinically relevant background auditory stimuli is necessary in order to better understand the impact of these findings in real-world settings and to test the clinical utility of VR technology for pain management relative to standard video game distraction.

Parents of Children With Food Allergy: Gender Differences in Perceived Impact and Perceived Food Allergy Severity

Objective

To compare fathers' and mothers' perceptions of the impact and severity of their child's food allergy and their levels of involvement in allergy-related care.

Methods

One hundred parents of children with food allergy (50 mother-father pairs) rated the severity of their child's food allergies and completed the Food Allergy Impact Scale. A subset of 52 parents reported how often they engaged in food allergy-related care.

Results

Mothers reported more impact than fathers for meal preparation, family social activities, and stress and free time, and significantly greater involvement in allergy-related care. Fathers who reported more frequent medical appointment attendance perceived meal preparation as being significantly more impacted by food allergy than fathers who were less involved.

Conclusions

Fathers who are less involved may be buffered from experiencing the impact of their child's health condition. Differences in involvement rather than other gender differences may explain discrepancies in mothers' and fathers' illness perceptions.

Parenting and independent problem-solving in preschool children with food allergy

OBJECTIVE

To examine autonomy-promoting parenting and independent problem-solving in children with food allergy.

METHODS

66 children with food allergy, aged 3-6 years, and 67 age-matched healthy peers and their mothers were videotaped while completing easy and difficult puzzles. Coders recorded time to puzzle completion, children's direct and indirect requests for help, and maternal help-giving behaviors.

RESULTS

Compared with healthy peers, younger (3- to 4-year-old) children with food allergy made more indirect requests for help during the easy puzzle, and their mothers were more likely to provide unnecessary help (i.e., explain where to place a puzzle piece). Differences were not found for older children.

CONCLUSIONS

The results suggest that highly involved parenting practices that are medically necessary to manage food allergy may spill over into settings where high levels of involvement are not needed, and that young children with food allergy may be at increased risk for difficulties in autonomy development.

Case study: videogame distraction reduces behavioral distress in a preschool-aged child undergoing repeated burn dressing changes: a single-subject design

OBJECTIVE

This single-subject design study evaluated the feasibility and efficacy of passive and interactive videogame distraction on behavioral distress for a preschool-aged child receiving repeated burn dressing changes.

METHOD

A 4-year-old girl underwent 3 baseline and 10 videogame distraction sessions (5 passive and 5 interactive) using a restricted alternating treatments design. Observed behavioral distress was coded, and parents and nurses rated the child's distress and cooperative behavior.

RESULTS

Relative to baseline, behavioral distress decreased and cooperative behavior increased immediately after the onset of videogame distraction. Single Case Randomization Tests revealed significantly lower behavioral distress and greater cooperation during interactive videogame distraction relative to passive videogame distraction.

CONCLUSIONS

Interactive videogame distraction appears to be a feasible and effective pain management strategy for a preschool-aged child undergoing repeated painful medical procedures.

Maternal intolerance of uncertainty, anxiety, and adherence with food challenge referrals

Anxiety regarding food challenges may serve an important role in parents’ decisions to adhere to their child’s food challenge referrals. This study examined the role of intolerance of uncertainty in food challenge referral adherence by assessing state/trait anxiety among mothers whose children were referred for a food challenge. Mothers whose children passed a food challenge reported significant decreases in anxiety regarding allergic reactions, but intolerance of uncertainty did not predict adherence. Trust in the physician was a primary reason mothers attended the food challenge, suggesting that physicians should consider the impact of the physician–patient relationship when treating these families.

The effects of interactive and passive distraction on cold pressor pain in preschool-aged children

OBJECTIVE

Using a mixed model design, this study examined the effects of interactive versus passive distraction on healthy preschool-aged children's cold pressor pain tolerance.

METHODS

Sixty-one children aged 3-5 years were randomly assigned to one of the following: interactive distraction, passive distraction, or no distraction control. Participants underwent a baseline cold pressor trial followed by interactive distraction trial, passive distraction trial, or second baseline trial. One or two additional trials followed. Children originally assigned to distraction received the alternate distraction intervention. Controls participated in both interactive and passive distraction trials in counterbalanced order.

RESULTS

Participants showed significantly higher pain tolerance during both interactive and passive distraction relative to baseline. The two distraction conditions did not differ.

CONCLUSIONS

Interactive and passive video game distraction appear to be effective for preschool-aged children during laboratory pain exposure. Future studies should examine whether more extensive training would enhance effects of interactive video game distraction.

Videogame distraction using virtual reality technology for children experiencing cold pressor pain: the role of cognitive processing

OBJECTIVE

This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain.

METHODS

Seventy-nine children ages 6-15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet.

RESULTS

As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task.

CONCLUSION

The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing.

Effects of videogame distraction and a virtual reality type head-mounted display helmet on cold pressor pain in young elementary school-aged children

OBJECTIVE

This study examined the effects of videogame distraction and a virtual reality (VR) type head-mounted display helmet for children undergoing cold pressor pain.

METHODS

Fifty children between the ages of 6 and 10 years underwent a baseline cold pressor trial followed by two cold pressor trials in which interactive videogame distraction was delivered via a VR helmet or without a VR helmet in counterbalanced order.

RESULTS

As expected, children demonstrated significant improvements in pain threshold and pain tolerance during both distraction conditions. However, the two distraction conditions did not differ in effectiveness.

CONCLUSIONS

Using the VR helmet did not result in improved pain tolerance over and above the effects of interactive videogame distraction without VR technology. Clinical implications and possible developmental differences in elementary school-aged children's ability to use VR technology are discussed.

Locus of Control and Peer Status: A Scale for Children's Perceptions of Social Interactions

A total of 985 third through sixth grade children participated in the development of a 48-item Locus of Control Scale for Children's Perceptions of Social Interactions (LOC-CPSI). Scores are based on the number of positive, negative, and total social reinforcers a child attributes to his or her own behavior (internal control). A social desirability subscale is included. Reliability coefficients were comparable to or greater than those of existing locus of control measures. Convergent validity was demonstrated by low, significant correlations with other locus of control measures. Internal scores correlated significantly with sociometric measures of popularity and predicted peer status better than other locus of control measures. Theoretical implications and potential clinical application are discussed.

Virtual-reality distraction and cold-pressor pain tolerance: does avatar point of view matter?

This study tested the effects of distraction using virtual-reality (VR) technology on acute pain tolerance in young adults. Forty-one undergraduate students, aged 18-23 years, used a VR head-mounted display helmet, steering wheel, and foot pedal to play an auto racing video game while undergoing exposure to very cold water (cold pressor set at 1 °C). Two different game views were tested that were hypothesized to affect the degree to which participants felt "present" in the virtual environment: a first-person view, in which the participant saw the virtual environment through the eyes of the game character being manipulated; and a third-person view, in which the participant viewed the game character from a distance. The length of time participants tolerated the cold-water exposure (pain tolerance) under each distraction condition was compared to a baseline (no distraction) trial. Subjects also rated the degree to which they felt "present" in the virtual environment after each distraction trial. Results demonstrated that participants had significantly higher pain tolerance during both VR-distraction conditions relative to baseline (no distraction) trials. Although participants reported a greater sense of presence during the first-person condition than the third-person condition, pain-tolerance scores associated with the two distraction conditions did not differ. The types of VR applications in which presence may be more or less important are discussed.

Sustained efficacy of virtual reality distraction

The current study tested whether the effectiveness of distraction using virtual reality (VR) technology in reducing cold pressor pain would maintain over the course of 8 weekly exposures. Twenty-eight adults, 18 to 23 years of age, underwent 1 baseline cold pressor trial and 1 VR distraction trial in randomized order each week. VR distraction led to significant increases in pain threshold and pain tolerance and significant decreases in pain intensity, time spent thinking about pain, and self-reported anxiety, relative to baseline. Repeated exposure did not appear to affect the benefits of VR. Implications for the long-term use of VR distraction as a nonpharmacological analgesic are discussed.

PERSPECTIVE

This article addresses the concern that the efficacy of virtual reality-assisted distraction from pain could potentially decrease with repeated exposure. The current finding that efficacy did not diminish over several repeated exposures provides support for the use of virtual reality as an adjuvant treatment of pain.

Magnitude of type 1 diabetes self-management in youth: health care needs diabetes educators

The purpose of this article is to demonstrate the complexity of the type 1 diabetes regimen and to highlight the essential role of the diabetes educator in safely training and implementing the myriad skills in a developmentally appropriate manner for children and adolescents. A review of literature and a task analysis were preformed and suggest that the complexity of the regimen is often not adequately addressed. Reviewed research assessed the regimen using measures with on average about 25 items while the task analysis contains over 600 tasks. The article discusses implications for clinical practice, including implications for measurement in research, targeting of interventions by diabetes educators, and the gradual transfer of regimen control to youth. It is argued that given the magnitude of the self-management task, education cannot be accomplished in the limited time that general practice physicians, pediatricians, or endocrinology specialists can spend with each patient. It is concluded that youth must be helped to internalize the importance of the regimen tasks and that transfer of these tasks to youth requires a developmentally sensitive approach to education. Diabetes educators serve an essential role in which they help young patients and their parents manage and master this overwhelming experience through promoting youth's involvement in tasks when full responsibility is not yet appropriate. The regimen is too complex for youth to undertake self-management without multidisciplinary support.

Effects of videogame distraction using a virtual reality type head-mounted display helmet on cold pressor pain in children

OBJECTIVE

To test whether a head-mounted display helmet enhances the effectiveness of videogame distraction for children experiencing cold pressor pain.

METHOD

Forty-one children, aged 6-14 years, underwent one or two baseline cold pressor trials followed by two distraction trials in which they played the same videogame with and without the helmet in counterbalanced order. Pain threshold (elapsed time until the child reported pain) and pain tolerance (total time the child kept the hand submerged in the cold water) were measured for each cold pressor trial.

RESULTS

Both distraction conditions resulted in improved pain tolerance relative to baseline. Older children appeared to experience additional benefits from using the helmet, whereas younger children benefited equally from both conditions. The findings suggest that virtual reality technology can enhance the effects of distraction for some children. Research is needed to identify the characteristics of children for whom this technology is best suited.

Active and passive distraction using a head-mounted display helmet: effects on cold pressor pain in children

OBJECTIVE

The current study tested the effectiveness of interactive versus passive distraction that was delivered via a virtual reality type head-mounted display helmet for children experiencing cold pressor pain.

DESIGN

Forty children, aged 5 to 13 years, underwent 1 or 2 baseline cold pressor trials followed by interactive distraction and passive distraction trials in counterbalanced order.

MAIN OUTCOME MEASURES

Pain threshold and pain tolerance.

RESULTS

Children who experienced either passive or interactive distraction demonstrated significant improvements in both pain tolerance and pain threshold relative to their baseline scores. In contrast, children who underwent a second cold pressor trial without distraction showed no significant improvements in pain tolerance or threshold.

CONCLUSION

Although both distraction conditions were effective, the interactive distraction condition was significantly more effective. Implications for the treatment of children's distress during painful medical procedures are discussed.

Evidence-based assessment of pediatric pain

OBJECTIVE

To conduct an evidence-based review of pediatric pain measures.

METHODS

Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as "Well-established," "Approaching well-established," or "Promising" according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work).

RESULTS

Eleven measures met criteria for "Well-established," six "Approaching well-established," and zero were classified as "Promising."

CONCLUSIONS

There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain.

The influence of preferred coping style and cognitive strategy on laboratory-induced pain

OBJECTIVE

To evaluate the effects of matching an individual's coping style (low, mixed, or high monitoring) to an appropriate cognitive strategy (distraction or sensation monitoring) to improve pain management.

DESIGN

This study used a split-plot factorial design in a laboratory setting.

MAIN OUTCOME MEASURES

Main outcomes were pain threshold, pain tolerance, pain intensity, pain affect, and anxiety.

RESULTS

The results of the 2 x 3 x 3 (Experimental Condition x Coping Style x Trial) analysis of variance (ANOVA) interaction were significant for pain threshold scores, F(4, 178) = 2.95, p < .01. Low monitors in the matched distraction trial had higher pain threshold scores than during baseline, t(15) = -2.68, p = .017, and the mismatched sensation monitoring trial, t(15) = 2.80, p = .014. High monitors' pain threshold scores were higher than baseline only during the matched sensation monitoring trial, t(27) = -2.75, p = .010. The results of the 2 x 3 x 3 ANOVA interaction were not significant for pain tolerance scores; however, when the mixed monitors were excluded, the 3-way interaction was significant, F(2, 124) = 3.48, p < .05. The results were nonsignificant for pain intensity, pain affect, and anxiety.

CONCLUSION

Results demonstrate that matching coping style to the appropriate cognitive strategy is important for improving pain threshold and pain tolerance; however, matching did not reduce pain intensity, pain affect, or anxiety. Future studies should explore the explanation for differential responses of high and low monitors and should test these hypotheses in a clinical setting.

The impact of food allergy on the daily activities of children and their families

BACKGROUND

Food allergy affects a significant number of children, and its management requires considerable time and vigilance.

OBJECTIVE

To determine the impact of food allergy on the daily activities of food allergic children and their families.

METHODS

Caregivers of food allergic children from a university-based allergy practice completed a questionnaire that evaluated their perception of the impact of their child's food allergy on family activities.

RESULTS

Of the 87 families who completed the study, more than 60% of caregivers reported that food allergy significantly affected meal preparation and 49% or more indicated that food allergy affected family social activities. Forty-one percent of parents reported a significant impact on their stress levels and 34% reported that food allergy had an impact on school attendance, with 10% choosing to home school their children because of food allergy. The number of food allergies had a significant impact on activity scores, but the existence of comorbid conditions such as asthma and atopic dermatitis did not significantly affect the results.

CONCLUSIONS

Food allergy has a significant effect on activities of families of food allergic children. Further study is needed to determine more detailed effects of food allergy on parent-child interactions and development.

When Distraction Fails: Parental Anxiety and Children’s Responses to Distraction during Cancer Procedures

OBJECTIVE

To examine parental anxiety in the context of successful and unsuccessful distraction treatment of preschool aged children undergoing chemotherapy procedures.

METHODS

Twenty-nine children (M age = 42 months) experiencing intramuscular or portacatheter injections participated in the study. Parents and children were shown how to use a portable electronic toy as a distractor during chemotherapy injections. Parental anxiety was assessed at baseline and child distress was coded during each procedure.

RESULTS

Parents' baseline state anxiety accounted for 17% of the variance in changes in children's distress following distraction intervention. Parents of children who did not benefit from distraction reported significantly higher state anxiety at baseline than parents of the other participants.

CONCLUSIONS

Results highlight the importance of examining individual outcomes in intervention studies and suggest that parents' emotional states may moderate distraction treatment outcome in young children. Future research formally testing parent anxiety as a moderator is recommended.

Memory in pediatric patients undergoing conscious sedation for aversive medical procedures

This study investigated preserved memory in 26 pediatric cancer patients (65% boys, 77% Caucasian, mean age = 12.5 years) undergoing midazolam-induced conscious sedation during painful medical procedures to treat hematological or oncological diseases. The sedative midazolam had a significant anterograde amnesic effect on participants' performance on a visual recognition (explicit) memory task but not on a visual perceptual facilitation (implicit) memory task. That implicit memory scores were relatively unaffected while explicit memory scores deteriorated significantly indicates that leaning occurred while participants were sedated, even when participants did not recollect the learning event. These findings, which replicate those of M. R. Polster, R. A. McCarthy, G. O'Sullivan, P. A. Gray, and G. R. Park (1993) in a study of adults, have implications for the development and treatment of conditioned anxiety reactions associated with aversive medical procedures.

Interactions between children with juvenile rheumatoid arthritis and their mothers

OBJECTIVE

To determine the degree to which mothers of children with juvenile rheumatoid arthritis (JRA) show an overprotective or highly controlling interaction style.

METHOD

We videotaped 84 mother-child pairs (42 JRA and 42 healthy, ages 6 to 13) while working on a collaborative problem-solving task. Based on physical therapy evaluations, children in the JRA group were assigned to "more severe" (n = 19) and "milder" (n = 22) arthritis subgroups.

RESULTS

Results showed numerous differences between mothers of children with more severe arthritis and the other mothers (no differences between the milder arthritis and healthy comparison groups were found). Compared to mothers in the other two groups, mothers of children with more severe arthritis were more directive of their children's behavior during the task, showing higher rates of structure and rule setting, general clues, and prompting the child for an answer.

DISCUSSION

Sequential analyses showed that mothers in the more severe group appeared to treat the task in a more evaluative manner, being more likely than other mothers to respond to correct answers with positive feedback and to incorrect answers with structure and rule setting. Mothers in the other groups were more likely to respond to both correct and incorrect answers with specific clues.

CONCLUSIONS

We discuss how these differences in interactional style might impact the social development of children with JRA.

Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access

This study evaluated a distraction intervention designed to reduce the distress of preschool children undergoing repeated chemotherapy injections. Twenty-nine children aged 2-5 years were randomly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control. Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition. The improvements were maintained over the 8-week intervention. The results suggest that a developmentally appropriate, multisensory, variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children.

Distraction for children of different ages who undergo repeated needle sticks

A distraction intervention for pain management and behavioral distress was implemented for six children with chronic illnesses and their parents as the children underwent repeated needle sticks. The children ranged in age from two to eight years. Several different cognitive distractors were used for the children based on their respective developmental levels. The needle stick procedures during which treatment was implemented included intramuscular injections, implanted port accesses, and intravenous placements. Nine sessions of distraction were provided in which a therapist taught parents to coach their children to use distraction techniques. Dependent measures included the child's behavioral distress and heart rate, parent ratings of the child's fear before the procedure, parent self-ratings of feeling upset during the procedure, and nurse ratings of the child's cooperation. Reductions in child behavioral distress during the distraction treatment program were observed in five out of the six cases. Concomitant improvements in parental reports of child distress, nurse estimates of child cooperation, and parents' self-report of feeling upset during the medical procedures also were found. Follow-up data were available for one of the successfully treated children. His improvements were maintained for both intramuscular injections and portacatheter accesses over 16 weeks without therapist involvement.

Reliability and validity of the brief behavioral distress scale: a measure of children's distress during invasive medical procedures

OBJECTIVE

To evaluate the reliability and validity of a new observational measure of children's procedure-related distress behaviors, the Brief Behavioral Distress Scale (BBDS), to provide clinicians with an efficient, economical alternative measure that does not depend on continuous interval coding.

METHODS

Forty-eight randomly selected videotaped invasive medical procedures performed on children (ages 2 to 10 years) with chronic illness were coded with the BBDS and the Observation Scale of Behavioral Distress (OSBD). Reliability and validity analyses along with item analysis were conducted.

RESULTS

Total distress scores of the BBDS were highly correlated with six of seven concurrent validity measures from multiple sources (i.e., OSBD, parent ratings, two nurse ratings, child self-report, and a physiological arousal measure, heart rate) (range r =.57-.76, p <.001-.0001). A robust association was found between the BBDS distress scores and OSBD total distress scores (r =.72, p <.0001). For two concurrent validity measures, the BBDS demonstrated stronger associations than did the OSBD. Interrater reliability was high for each BBDS distress behavior category.

CONCLUSIONS

Based on the findings reported, the BBDS is a reliable and valid measure of children's procedure-related distress with functional utility in both research and clinical settings.

Body image and psychosocial adjustment in adolescent cancer survivors

Examined body image and social adjustment in 21 adolescents who had completed cancer treatment and a healthy comparison group. Subjects completed questionnaires assessing body image and social adjustment and were videotaped during an interview. Raters blind to health status independently rated subjects' attractiveness. Cancer survivors reported less than half as many social activities as the healthy controls. No group differences were found on social anxiety, loneliness, or composite body image scores. However, within the cancer group, adolescents who had been off treatment longer reported lower self-worth, more social anxiety, and more negative body image perceptions, but were not rated as less attractive by observers. Findings suggest body image concerns and social anxiety may not develop until several years after treatment termination.

Parents of children with cancer: a longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis

Evaluated emotional distress, coping style, and marital adjustment in 84 parents (42 couples) of children with cancer 2 months after diagnosis and again about 20 months after diagnosis. As expected, mothers' mean state anxiety and trait anxiety scores decreased to near normal levels over time. Fathers' scores were lower initially and did not change. Neither mothers' nor fathers' mean marital adjustment scores changed over time. Marital adjustment at treatment follow-up was predicted by depression and the spouse's marital satisfaction in mothers, and depression, child health status, and spouse's marital satisfaction in fathers. In contrast to findings obtained 2 months after diagnosis, coping style was not related to marital adjustment at follow-up. Results are discussed in terms of possible gender differences in the role of social support in marital adjustment and the stability versus situational specificity of coping styles.

Physician and parent behavior during invasive pediatric cancer procedures: relationships to child behavioral distress

Observed 51 children with cancer, their parents, and their physicians during routine bone marrow aspirations and lumbar punctures. Child distress was measured via the Observational Scale of Behavioral Distress (OSBD); adult behaviors were coded via the Child Adult Medical Procedure Interaction Scale (CAMPIS). In general, physicians were less verbally interactive than parents both before and during the procedure. As expected, several parent behaviors were positively related to child distress. However, physician behaviors were uniformly negatively related to child distress. Findings are discussed in terms of the physician-patient relationship and the possible role of physicians as change agents in reducing child distress during invasive procedures.

Brief report: adherence-facilitating behaviors of a multidisciplinary pediatric rheumatology staff

Investigated the behaviors of pediatric rheumatology health care providers that were expected to be related to patient or parent adherence. Medical charts of 108 patients ages 1 to 20 years diagnosed with Juvenile Rheumatoid Arthritis were examined. The 473 outpatient visits over 15 months yielded a total of 2,578 treatment recommendations, but only 1,390 adherence-facilitating behaviors by medical staff were documented. Providing information about how often to perform the recommendation was the most common staff behavior. In contrast, care providers rarely indicated that they addressed their patients' concerns and barriers to implementing the recommendations, or employed behavior modification strategies to increase adherence. Implications of these findings for development of programs designed to increase treatment adherence in children with chronic diseases requiring time-consuming, intrusive medical regimens are discussed.

Parenting and child distress during cancer procedures: a multidimensional assessment

We examined the relationship between children's distress during invasive cancer procedures and parent anxiety, parent disciplinary attitudes, and parent behavior during the medical procedure. Sixty-six children with cancer and their parents were evaluated during a routine bone marrow aspiration. Significantly higher levels of distress were obtained for young (under age 8) versus older children. Patterns of relationships with parent variables also varied by age. Anxious parents of young children reported relying on less effective discipline strategies. They also were less reassuring prior to to medical procedure. Age differences in the correlations between child distress and parenting are discussed in terms of developmental differences in children's dependence on caregivers for emotional regulation and control. Implications for clinical distress reduction programs are also discussed.

Correlates of psychiatry grand rounds attendance

Although grand rounds is an important educational conference in most medical schools and psychiatry departments, there have been few studies of which variables influence faculty and trainee attendance. The authors hypothesized that psychiatry grand rounds attendance would be affected by content area, the speaker's discipline and geographic origin, and the label of "research" in the presentation title. In 3 years of grand rounds presentations at the Baylor College of Medicine Department of Psychiatry and Behavioral Sciences, fewer residents attended grand rounds when "research" was in the label and attendance was greater when the rounds were cosponsored by another agency, presented in honor of someone, or given by an out-of-town speaker.

Parents of children newly diagnosed with cancer: anxiety, coping, and marital distress

Evaluated anxiety, approach-avoidance coping style, and marital distress in 134 parents of children with cancer shortly after diagnosis. Of the 67 marital pairs studied, approximately 25% of the mothers and 28% of the fathers reported significant marital distress. Regression analyses revealed that marital distress was predicted by a combination of general emotional distress, the discrepancy between the couple's state anxiety levels, and the couple's use of sensitizing coping strategies. Greater differences in anxiety levels between the parents and greater stimulus approach coping activity in the marriage were associated with greater reported marital distress.