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Canavera K, Marik P, Schneider NM, Smith J. The Role of Pediatric Psychologists in Critical Care: Lessons Learned and Future Directions in Integrating Mental Health Care Into PICUs. Chest 2024:S0012-3692(24)00398-2. [PMID: 38513964 DOI: 10.1016/j.chest.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Pediatric psychologists are essential staff in the PICU. Their role in caring for critically ill children aligns with clinical practice guidelines for the mental health care needs of this population of patients. This article highlights the role of pediatric psychology in the PICU through illustrative case examples. We discuss lessons learned and future directions for the development and provision of mental health services in PICUs. We address relevant ways for critical care providers to understand the importance of evidence-based psychological care and advocate for the inclusion of psychologists on multidisciplinary PICU teams. As the critical care field continues to focus on an improved understanding of post-intensive care syndrome in pediatrics and the psychological needs of critical care patients, it will be important to consider the vital roles of psychologists and to advocate for improved integration of mental health care in PICUs.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA.
| | - Patricia Marik
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Nicole M Schneider
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jacquelyn Smith
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
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2
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King KP, Humiston T, Gowey MA, Murdaugh DL, Dutton GR, Lansing AH. A biobehavioural and social-structural model of inflammation and executive function in pediatric chronic health conditions. Health Psychol Rev 2024; 18:24-40. [PMID: 36581801 PMCID: PMC10307927 DOI: 10.1080/17437199.2022.2162430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Evidence indicates that pediatric chronic health conditions (CHCs) often impair executive functioning (EF) and impaired EF undermines pediatric CHC management. This bidirectional relationship likely occurs due to biobehavioural and social-structural factors that serve to maintain this feedback loop. Specifically, biobehavioural research suggests that inflammation may sustain a feedback loop that links together increased CHC severity, challenges with EF, and lower engagement in health promoting behaviours. Experiencing social and environmental inequity also maintains pressure on this feedback loop as experiencing inequities is associated with greater inflammation, increased CHC severity, as well as challenges with EF and engagement in health promoting behaviours. Amidst this growing body of research, a model of biobehavioural and social-structural factors that centres inflammation and EF is warranted to better identify individual and structural targets to ameliorate the effects of CHCs on children, families, and society at large. This paper proposes this model, reviews relevant literature, and delineates actionable research and clinical implications.
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Affiliation(s)
| | - Tori Humiston
- University of Vermont, Department of Psychological Sciences
| | - Marissa A. Gowey
- University of Alabama-Birmingham School of Medicine, Department of Pediatrics
| | - Donna L. Murdaugh
- University of Alabama-Birmingham School of Medicine, Department of Pediatrics
| | - Gareth R. Dutton
- University of Alabama-Birmingham School of Medicine, Department of Preventive Medicine
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3
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Leith TB, Forer R, Rappaport L, Malas N, McCaffery H, Sturza J, Kullgren K, Otto A, Monroe K. Virtual Schooling and Pediatric Mental Health During the COVID-19 Pandemic. Clin Pediatr (Phila) 2024; 63:80-88. [PMID: 37937539 DOI: 10.1177/00099228231209671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
In this single-site, retrospective, descriptive chart review and survey, we investigated changes in pediatric behavioral health needs during the COVID-19 pandemic and the relationship between virtual schooling and hospitalized children's mental health. Subjects included patients aged 6 and 18 years during the 2015 to 2019 and 2020 to 2021 school years who received inpatient mental health care. Parents of patients admitted in 2020 to 2021 were surveyed regarding their child's schooling. We additionally described and compared subjects using descriptive data, including proxies for illness severity, and assessed how these outcomes changed during the pandemic and correlated with school modality. During the pandemic, the distribution of diagnoses changed, and some markers of severity increased. Patients in exclusively virtual school had higher rates of mood and anxiety disorders and tic disorders, and lower rates of eating and disruptive behavior disorders, than patients with recent in-person school. Further study is needed regarding the impact of virtual schooling on pediatric mental health.
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Affiliation(s)
- Thomas B Leith
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Reni Forer
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Leah Rappaport
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Nasuh Malas
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Harlan McCaffery
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristin Kullgren
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alana Otto
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kimberly Monroe
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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4
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Soni U, Sharma R, Sharma M, Khurana E, Chopra J, Julka D, Gaur N. Impulsivity and Risk-Taking Behavior in School-Going Adolescents. Cureus 2023; 15:e40728. [PMID: 37485185 PMCID: PMC10360448 DOI: 10.7759/cureus.40728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Impulsivity (or impulsiveness) and risk-taking behavior are significant concerns as the adolescent population is at a higher risk of injuries and violence, unhealthy sexual behaviors, and drug- and alcohol-related problems. The early identification of these traits in adolescents can prove beneficial through timely interventions. This study was conducted to assess impulsive behavior and risk-taking behavior among school-going adolescents in New Delhi, India, and to study the association, if any, between the two. Methodology A cross-sectional study was conducted among 571 students of classes 9th-10th in three randomly selected schools in a part of Delhi, India. Barratt Impulsiveness Scale - Brief (BIS-Brief) was used to evaluate impulsivity, and risk-taking behavior was assessed using the RT-18 tool. Results The majority (72.3%) of the 571 students were aged 14-15 years. Among the students, 56.0% were males. The impulsivity score obtained ranged from 8 to 30, with a mean score of 15.7 (SD ±4.1). The risk-taking score ranged from 2 to 18, with a mean score of 9.9 (SD ±2.9). Impulsivity was seen to be significantly higher among the female students (p=0.004). The risk-taking behavior was significantly higher among the students from government schools, among the females, and among those who used the internet more. There was a significant direct association between impulsivity and risk-taking behavior among the students (correlation coefficient 0.301, p<0.001). Conclusion The study results showed that the mean impulsivity and risk-taking scores were comparable to other studies in adolescent age groups done internationally using the same tools. Impulsivity and risk-taking behavior were both found to be higher among females. There was a significant direct association between impulsivity and risk-taking.
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Affiliation(s)
- Ujjwal Soni
- Medicine, University College of Medical Sciences, New Delhi, IND
| | - Rahul Sharma
- Community Medicine, University College of Medical Sciences, New Delhi, IND
| | - Marisha Sharma
- Paediatrics, Lady Hardinge Medical College, New Delhi, IND
| | - Ekta Khurana
- Clinical Psychology, Gautam Buddha University, Greater Noida, IND
| | - Jayesh Chopra
- Medicine, University College of Medical Sciences, New Delhi, IND
| | - Dhawani Julka
- Medicine, University College of Medical Sciences, New Delhi, IND
| | - Nikhil Gaur
- Medicine, University College of Medical Sciences, New Delhi, IND
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Robins PM, Stancin T. Commentary: Goldilocks Revisited: Do We Need More Practice Competencies in Pediatric Psychology? J Pediatr Psychol 2023:7152463. [PMID: 37141576 DOI: 10.1093/jpepsy/jsad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023] Open
Abstract
The publication of the Thompson et al. competencies framework for pediatric palliative care marks a third set of practice guidelines published. There is essential tension between specialist training in clinical child psychology (our "home" discipline) leading to further subspecialty training in pediatric psychology, the desired balance between the two, and impact on teaching, training, and patient care. A purpose of this invited commentary is to stimulate further awareness and subsequent discussion of the integration of more narrow practice skills in a growing and developing field, as the tendency toward greater specialization and siloed practice increases.
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Affiliation(s)
- Paul M Robins
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 4601 Market St, Third Floor, Philadelphia, PA 19139, USA
| | - Terry Stancin
- Emeritus Chief of Psychology, The MetroHealth System, Case Western Reserve University, USA
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6
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Shimizu H. The Impact of Working Memory on the Development of Social Play in Japanese Preschool Children: Emotion Knowledge as a Mediator. Children (Basel) 2023; 10:children10030524. [PMID: 36980082 PMCID: PMC10047190 DOI: 10.3390/children10030524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Through enriched play, children learn social-emotional skills necessary for academic achievement and interpersonal relationships with others. Further research is needed on how specific factors associated with social play, such as working memory and emotion knowledge, interact to promote it. Previous studies have examined the association of working memory and emotion knowledge with social play. However, there are no consistent results as to which abilities influence which skills first. Thus, the present study examines the impact of working memory on the development of social play and the role of emotion knowledge in the relationship between working memory and social play. Forty-seven Japanese preschoolers were tested on working memory, social play, and emotion knowledge. Regression analysis indicated that working memory was significantly related to social play. Furthermore, mediation analysis indicated that emotion recognition mediates the effects of working memory on social play. Working memory was found to contribute to social play by improving emotion recognition in children. These results indicate that the pathway from working memory to social play is mediated by emotion recognition and expands previous perspectives on the developmental mechanisms of emotion knowledge in children.
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Affiliation(s)
- Hisayo Shimizu
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima 7398524, Japan
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Dahl CM, Bauer MJ, Kroupina M. DC: 0-5 system in clinical assessment with specialty pediatric populations. Infant Ment Health J 2023; 44:372-386. [PMID: 36857410 DOI: 10.1002/imhj.22034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/21/2022] [Indexed: 03/02/2023]
Abstract
Early childhood mental health (ECMH) programs provide an opportunity to provide specialized mental health services to vulnerable young children and connect them with necessary evidence-based early intervention. However, there is a paucity of descriptive and explorative studies of the clinic protocols in the literature. Even within published work, there is a lack of standardization in clinical models and diagnostic systems limiting comparison and extrapolation. This paper describes how the DC: 0-5 framework guides the development of the model for an ECMH clinic embedded in the context of academic pediatrics. It also highlights the opportunity the DC 0-5 presents for developing the standardized protocols and a mechanism for standardized data collection in clinical settings. The paper demonstrates the utility of using the DC 0-5 in protocol development, assessment and data collection the mental health assessments of 87 children ages 0-6 were reviewed to gather information on history, presenting problems, parent-child relationship, and mental health diagnoses. This paper and associated data underscore the utility and necessity of ECMH clinics while identifying challenges in the field.
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Affiliation(s)
- Claire M Dahl
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maya J Bauer
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria Kroupina
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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King KP, Keller CV, Evans CT, Murdaugh DL, Gower BA, Gowey MA. Inflammation, Executive Function, and Adiposity in Children With or at Risk for Obesity: A Pilot Study. J Pediatr Psychol 2023; 48:134-143. [PMID: 36111823 PMCID: PMC10167924 DOI: 10.1093/jpepsy/jsac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Obesity is associated with executive function (EF) deficits across the lifespan. Higher body mass index (BMI), obesity severity, and poorer adherence and weight outcomes in obesity treatment have all been associated with EF deficits. Adult literature has begun to emphasize neuroinflammation in obesity as a possible pathway to later cognitive impairment in EF. However, pediatric obesity literature has yet to establish associations between peripheral inflammation and EF. Thus, the present study examined associations and variability in inflammation, EF, and adiposity in children with or at risk for obesity. Additionally, inflammation was examined as a mediator of the relationship between adiposity and EF. METHODS Children (N = 39) aged 8-12 years with BMI ≥ 50th percentile were recruited. The NIH Toolbox Cognitive Battery was used to assess performance-based EF. Peripheral inflammation was assessed in fasted sera. Dual-energy X-ray absorptiometry scans were conducted to assess body composition. Linear regression and Hayes' PROCESS Model 4 (Hayes, 2017) were used to evaluate associations between adiposity and inflammation, inflammation and EF, and whether adiposity effects EF through its effect on inflammation. RESULTS Positive associations were identified between adiposity and inflammation, and negative to null associations were identified between inflammation and EF. Medium indirect effects of adiposity on EF through inflammation were detected. CONCLUSION Pilot evidence suggests greater adiposity is linked with greater inflammation, which in turn is associated with less EF in some domains. Directionality and causality cannot yet be established, but with replication, findings may inform efforts to target EF in pediatric obesity.
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Affiliation(s)
- Kathryn P King
- Department of Psychology, University of Alabama at Birmingham, USA
| | | | - Corinne T Evans
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, USA
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - Marissa A Gowey
- Department of Pediatrics, University of Alabama at Birmingham, USA
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9
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Sparanese S, Yeates KO, Bone J, Beauchamp MH, Craig W, Zemek R, Doan Q. Concurrent Psychosocial Concerns and Post-Concussive Symptoms Following Pediatric mTBI: An A-CAP Study. J Pediatr Psychol 2023; 48:156-165. [PMID: 36308773 DOI: 10.1093/jpepsy/jsac076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To measure the association between psychosocial problems and persistent post-concussive symptoms (PCS) in youth who were seen in the emergency department with mild traumatic brain injury (mTBI) or orthopedic injury (OI). METHODS From a larger prospective cohort study, Advancing Concussion Assessment in Pediatrics (A-CAP), 122 child-guardian pairs who presented to the emergency department with mTBI (N = 70) or OI (N = 52) were recruited for this cross-sectional sub-study. Each pair completed 2 measures assessing PCS burden at 2 weeks, 3 months, and 6 months post-injury. At one visit, pairs concurrently completed MyHEARTSMAP, a comprehensive, psychosocial self-assessment tool to evaluate 4 domains of mental wellness. RESULTS When measured at the same visit, children who self-reported moderate or severe Psychiatry domain concerns concurrently experienced a greater burden of cognitive symptoms (β = 5.49; 0.93-10.05) and higher overall PCS count (β = 2.59; 0.70-4.48) after adjusting for covariables, including retrospective pre-injury symptoms and injury group. Additionally, reports indicating mild Function domain severity were associated with increased cognitive (β = 3.34; 95% CI: 0.69-5.99) and somatic symptoms (β = 6.79; 2.15-11.42) and total symptom count (β = 1.29; 0.18-2.39). CONCLUSION Increasing severity in multiple domains of mental health is associated with more PCS in youth. While the differences in PCS between the mTBI and OI groups appeared somewhat larger for children with more mental health concerns, the interaction was not statistically significant; larger sample sizes are needed to evaluate the moderating effect of psychosocial difficulties on post-concussion symptoms.
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Affiliation(s)
| | | | - Jeffrey Bone
- BC Children's Hospital Research Institute, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Canada
| | - Quynh Doan
- BC Children's Hospital Research Institute, Canada
- Department of Pediatrics, University of British Columbia Faculty of Medicine, Canada
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10
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Rangu S, Collins J, García-Romero MT, Augsburger BD, Bruckner AL, Diaz LZ, Eichenfield LF, Faig W, Gorell ES, Lefferdink R, Lucky AW, Morel KD, Paller AS, Park H, Pastrana-Arellano E, Peoples K, Wiss K, Perman MJ, Castelo-Soccio L. Assessing pain catastrophizing and functional disability in pediatric epidermolysis bullosa patients. Pediatr Dermatol 2022; 40:422-427. [PMID: 36579717 DOI: 10.1111/pde.15220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES The primary objective was to assess pain catastrophizing and functional disability in pediatric patients with epidermolysis bullosa (EB) and their parents/guardians. Secondary objectives included examining relationships between pain catastrophizing, functional disability, and correlations with other factors (e.g., age, disease severity, and percent of body surface area (BSA) involved). METHODS Patients with EB ages 8-16 and their parents/guardians who were English or Spanish speaking completed a one-time online survey. Parent measures included: demographics questionnaire, Pain Catastrophizing Scale-Parent (PCS), and Parent Functional Disability Inventory (FDI). Child measures included: PCS child and child FDI. Higher scores on both scales indicate higher levels of catastrophizing and functional disability. RESULTS Of 31 children, the mean age was 11.47 years and the majority (70.97%) had dystrophic EB. Mean scores were: 35.84 = PCS parent; 34.58 = PCS child; 30.87 = parent FDI; 29.77 = child FDI. Total scores for PCS parent, parent FDI, and child FDI increased significantly with disease severity and percentage of involved BSA (p < .01 for all). Total scores for PCS child increased significantly with percent of EB skin involvement (p = .04) but not disease severity. Older children reported more functional disability than their parents and younger children (p = .02). CONCLUSIONS Our results demonstrate significant positive correlations between negative thoughts related to pain and the experience of functional difficulties in patients with EB and their caregivers. Psychological, psychiatric, and/or behavioral interventions to help managing chronic pain may be effective for patients with EB.
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Affiliation(s)
- Sneha Rangu
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica Collins
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Bret D Augsburger
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lucia Z Diaz
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego, San Diego, California, USA.,Department Pediatrics, University of California San Diego, San Diego, California, USA.,Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Walter Faig
- Children's Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, USA
| | - Emily S Gorell
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne W Lucky
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kimberly D Morel
- Department of Dermatology, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA.,Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Amy S Paller
- Children's Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, USA
| | - Helen Park
- Department Pediatrics, University of California San Diego, San Diego, California, USA
| | | | - Kathleen Peoples
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marissa J Perman
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leslie Castelo-Soccio
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
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11
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Reasoner EE, van der Plas E, Al-Kaylani HM, Langbehn DR, Conrad AL, Schultz JL, Epping EA, Magnotta VA, Nopoulos PC. Behavioral features in child and adolescent huntingtin gene-mutation carriers. Brain Behav 2022; 12:e2630. [PMID: 35604958 PMCID: PMC9304841 DOI: 10.1002/brb3.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/11/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION We compared neuropsychiatric symptoms between child and adolescent huntingtin gene-mutation carriers and noncarriers. Given previous evidence of atypical striatal development in carriers, we also assessed the relationship between neuropsychiatric traits and striatal development. METHODS Participants between 6 and 18 years old were recruited from families affected by Huntington's disease and tested for the huntingtin gene expansion. Neuropsychiatric traits were assessed using the Pediatric Behavior Scale and the Behavior Rating Inventory of Executive Function. Striatal volumes were extracted from 3T neuro-anatomical images. Multivariable linear regression models were conducted to evaluate the impact of group (i.e., gene nonexpanded [GNE] or gene expanded [GE]), age, and trajectory of striatal growth on neuropsychiatric symptoms. RESULTS There were no group differences in any behavioral measure with the exception of depression/anxiety score, which was higher in the GNE group compared to the GE group (estimate = 4.58, t(129) = 2.52, FDR = 0.051). The growth trajectory of striatal volume predicted depression scores (estimate = 0.429, 95% CI 0.15:0.71, p = .0029), where a negative slope of striatal volume over time was associated with lower depression/anxiety. CONCLUSIONS The current findings show that GE children may have lower depression/anxiety compared to their peers. Previously, we observed a unique pattern of early striatal hypertrophy and continued decrement in volume over time among GE children and adolescents. In contrast, GNE individuals largely show striatal volume growth. These findings suggest that the lower scores of depression and anxiety seen in GE children and adolescents may be associated with differential growth of the striatum.
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Affiliation(s)
- Erin E Reasoner
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Hend M Al-Kaylani
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Douglas R Langbehn
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Amy L Conrad
- Stead Family Children's Hospital at the University of Iowa, Iowa City, Iowa, USA
| | - Jordan L Schultz
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Eric A Epping
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.,Stead Family Children's Hospital at the University of Iowa, Iowa City, Iowa, USA.,Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
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12
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Metcalfe RE. Open Science Within Pediatric Medical and Mental Health Systems: Practical Considerations for Behavioral Health Researchers. Front Psychol 2022; 13:856949. [PMID: 35310242 PMCID: PMC8927712 DOI: 10.3389/fpsyg.2022.856949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Robyn E Metcalfe
- Department of Counseling, Family and Human Services, University of Oregon, Eugene, OR, United States
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13
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Fogler JM, Ratliff-Schaub K, McGuinn L, Crutchfield P, Schwartz J, Soares N. OpenNotes: Anticipatory Guidance and Ethical Considerations for Pediatric Psychologists in Interprofessional Settings. J Pediatr Psychol 2021; 47:189-194. [PMID: 34383944 DOI: 10.1093/jpepsy/jsab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The 21st Century Cures Act included an "OpenNotes" mandate to foster transparent communication among patients, families, and clinicians by offering rapid electronic access to clinical notes. This article seeks to address concerns about increased documentation burden, vulnerability to patient complaints, and other unforeseen consequences of patients having near-real-time access to their records. METHODS This topical review explores both extant literature, and case examples from the authors' direct experience, about potential responses/reactions to OpenNotes. RESULTS The ethics of disclosing medical information calls for nuanced approaches: Although too little access can undermine a patient's autonomy and the capacity for truly egalitarian shared decision-making, unfettered access to all medical information has significant potential to harm them. Suggested strategies for mitigating risks in premature disclosure include patient and provider education and "modularizing" sensitive information in notes. CONCLUSION The OpenNotes era has ushered in the possibilities of greater patient and family collaboration in shared decision-making and reduced barriers to documentation sharing. However, it has raised new ethical and clinician documentation considerations. In addition to clinician education, patients and families could benefit from education around the purpose of clinical documentation, how to utilize OpenNotes, and the benefits of engaging in dialogue regarding the content and tone of documentation.
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Affiliation(s)
- Jason M Fogler
- Boston Children's Hospital and Harvard Medical School, USA
| | - Karen Ratliff-Schaub
- Prisma Health and University of South Carolina School of Medicine Greenville, USA
| | | | | | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
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14
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Kamody RC, Kamody ES, Rosenthal A, Olezeski CL. Optimizing Medical-Legal Partnerships in Pediatric Psychology to Reduce Health Disparities. J Pediatr Psychol 2021; 47:69-74. [PMID: 34313766 DOI: 10.1093/jpepsy/jsab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To provide a topical review of the literature on the use of medical-legal partnerships (MLPs) to address social determinants of health (SDH) needs as a means to reduce health disparities, and to make recommendations for the implementation of MLPs within pediatric psychologists' clinical work, research, and training. METHODS We conducted a topical review of the research on the intersection of MLPs, SDH needs, and health disparities among pediatric populations. Given the scarcity of literature available, both empirical and theoretical articles were included in the review. RESULTS Though limited, the extant literature suggests that use of MLPs may help address the SDH needs that perpetuate disparities among pediatric populations. To date, MLPs are not as frequently incorporated in the training and work of pediatric psychologists as they may be in other related fields (e.g., medicine). CONCLUSIONS MLPs provide an opportunity for psychologists to broaden their interdisciplinary collaborations, to more aptly meet the social and legal needs of their patients to assist in reducing inequities among underserved pediatric populations. The systematic incorporation of MLPs into pediatric psychology training may help to increase the utilization of these services moving forward.
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Affiliation(s)
- Rebecca C Kamody
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.,Yale Gender Program, Yale School of Medicine, New Haven, CT, USA
| | | | - Alice Rosenthal
- Yale Gender Program, Yale School of Medicine, New Haven, CT, USA.,Center for Children's Advocacy at Yale New Haven Hospital, New Haven, CT, USA
| | - Christy L Olezeski
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.,Yale Gender Program, Yale School of Medicine, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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15
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Price J, Beidas RS, Wolk CB, Genuario K, Kazak AE. Implementation Science in Pediatric Psychology: The Example of Type 1 Diabetes. J Pediatr Psychol 2020; 44:1068-1073. [PMID: 31045228 DOI: 10.1093/jpepsy/jsz030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/07/2019] [Accepted: 04/08/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Evidence-based screening, assessment, and intervention practices for youth with type 1 diabetes (T1D) are underutilized. Implementation science (IS) offers theoretical models and frameworks to guide rigorous mixed methods research to advance comprehensive care for children and families. METHODS We conducted a targeted review of applications of IS to T1D. RESULTS Pediatric T1D research offers initial, but still limited studies on implementation of evidence-based psychosocial care. IS designates approaches to understanding multi-level factors that influence implementation, ways to alter these factors, and methods to evaluate strategies to improve implementation. CONCLUSIONS IS is promising for advancing the translation of pediatric psychology approaches into clinical care. Following the science of implementation, further documentation of the reach of evidence-based care and establishing practice guidelines are important initial steps. Examining the barriers and facilitators of evidence-based psychosocial care can guide the development of testable implementation strategies to improve integration of care. Successful strategies can be evaluated through multi-site controlled implementation trials to explore their effectiveness. These lines of inquiry can be considered within pediatric populations, but may also be used to examine similarities and differences in effectiveness of implementation strategies across populations and settings. Such research has the potential to improve the health and well-being of children and families.
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Affiliation(s)
- Julia Price
- Nemours Children's Health System, Sidney Kimmel Medical School of Thomas Jefferson University
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania
- Department of Medical Ethics and Health Policy, University of Pennsylvania
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania
| | | | | | - Anne E Kazak
- Nemours Children's Health System, Sidney Kimmel Medical School of Thomas Jefferson University
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16
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Rose M, Streisand R, Tully C, Clary L, Monaghan M, Wang J, Mackey E. Risk of Disordered Eating Behaviors in Adolescents with Type 1 Diabetes. J Pediatr Psychol 2020; 45:583-591. [PMID: 32388559 DOI: 10.1093/jpepsy/jsaa027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Management of type 1 diabetes (T1D) may be difficult for adolescents, who often fail to meet glycemic targets. Adolescents are also at an increased risk for negative affect (i.e., anxiety, depressive symptoms) and are prone to disordered eating behaviors (DEB). This study hypothesized that negative affect would be associated with DEB, self-management, and glycemic control, but that this would be moderated by negative urgency (the urge to engage in impulsive behaviors in response to negative affect), such that this relationship would be significant only for those with higher negative urgency. METHODS The Eating in Adolescents with T1D Study recruited 100 caregiver-adolescent dyads (55% male youth, 48% Caucasian) to complete questionnaires reporting on the adolescent's negative affect, negative urgency, DEB, and diabetes management. Glycemic control 3-4 months following survey completion was extracted from the medical record. RESULTS A total of 61% of adolescents reported elevated symptoms of anxiety or depression and 25% reported elevated disordered eating symptoms. A total of 81% of adolescents had an A1c level above recommended targets. Negative affect was associated with DEB, suboptimal T1D self-management, and suboptimal glycemic outcomes, moderated by higher levels of negative urgency. Negative affect was associated directly with suboptimal self-management and glycemic control, but not DEB, at all levels of negative urgency. CONCLUSIONS Adolescents reported high levels of negative affect, DEB, and suboptimal glycemic control. Interventions that target negative affect and negative urgency in adolescents with T1D are needed in order to reduce the risk for DEB and negative diabetes health outcomes.
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Affiliation(s)
| | - Randi Streisand
- Children's National Hospital.,George Washington University School of Medicine
| | - Carrie Tully
- Children's National Hospital.,George Washington University School of Medicine
| | - Lauren Clary
- Children's National Hospital.,George Washington University School of Medicine
| | - Maureen Monaghan
- Children's National Hospital.,George Washington University School of Medicine
| | - Jichuan Wang
- Children's National Hospital.,George Washington University School of Medicine
| | - Eleanor Mackey
- Children's National Hospital.,George Washington University School of Medicine
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17
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de Medeiros CB, Moxon-Emre I, Scantlebury N, Malkin D, Ramaswamy V, Decker A, Law N, Kumabe T, Leonard J, Rubin J, Jung S, Kim SK, Gupta N, Weiss W, Faria CC, Vibhakar R, Lafay-Cousin L, Chan J, Kros JM, Janzen L, Taylor MD, Bouffet E, Mabbott DJ. Medulloblastoma has a global impact on health related quality of life: Findings from an international cohort. Cancer Med 2019; 9:447-459. [PMID: 31755223 PMCID: PMC6970040 DOI: 10.1002/cam4.2701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background Understanding the global impact of medulloblastoma on health related quality of life (HRQL) is critical to characterizing the broad impact of this disease and realizing the benefits of modern treatments. We evaluated HRQL in an international cohort of pediatric medulloblastoma patients. Methods Seventy‐six patients were selected from 10 sites across North America, Europe, and Asia, who participated in the Medulloblastoma Advanced Genomics International Consortium (MAGIC). The Health Utilities Index (HUI) was administered to patients and/or parents at each site. Responses were used to determine overall HRQL and attributes (ie specific subdomains). The impact of various demographic and medical variables on HRQL was considered—including molecular subgroup. Results The majority of patients reported having moderate or severe overall burden of morbidity for both the HUI2 and HUI3 (HUI2 = 60%; HUI3 = 72.1%) when proxy‐assessed. Self‐care in the HUI2 was rated as higher (ie better outcome) for patients from Western versus Eastern sites, P = .02. Patients with nonmetastatic status had higher values (ie better outcomes) for the HUI3 hearing, HUI3 pain, and HUI2 pain, all P < .05. Patients treated with a gross total resection also had better outcomes for the HUI3 hearing (P = .04). However, those who underwent a gross total resection reported having worse outcomes on the HUI3 vision (P = .02). No differences in HRQL were evident as a function of subgroup. Conclusions By examining an international sample of survivors, we characterized the worldwide impact of medulloblastoma. This is a critical first step in developing global standards for evaluating long‐term outcomes.
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Affiliation(s)
| | - Iska Moxon-Emre
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Nadia Scantlebury
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Alexandra Decker
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
| | - Nicole Law
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
| | | | | | - Josh Rubin
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Shin Jung
- Chonnam National University, Hwasun-gun, Korea
| | - Seung-Ki Kim
- Seoul National University Hospital, Seoul, Korea
| | - Nalin Gupta
- University of California San Francisco, San Francisco, CA, USA
| | - William Weiss
- University of California San Francisco, San Francisco, CA, USA
| | - Claudia C Faria
- Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - Lucie Lafay-Cousin
- Alberta Children's Hospital, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | - Jennifer Chan
- Alberta Children's Hospital, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | - Johan M Kros
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laura Janzen
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Surgery, Department of Laboratory Medicine and Pathobiology and Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Eric Bouffet
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald J Mabbott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
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18
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Renner G, Schroeder A, Irblich D. [Discriminative Validity of the Wechsler Intelligence Scale for Children - IV (WIS) in a Social-Pediatric Sample]. Prax Kinderpsychol Kinderpsychiatr 2019; 68:183-97. [PMID: 30838949 DOI: 10.13109/prkk.2019.68.3.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Discriminative Validity of the Wechsler Intelligence Scale for Children - IV (WIS) in a Social-Pediatric Sample This study presents data on the discriminative validity of the Wechsler Scale of Intelligence for Children - IV (WIS) for clinical diagnoses, different types of schooling, and variables related to migration. The sample comprises 631 children aged 6 to 13 who were tested with the WIS core tests in German centers of social pediatrics (Sozialpädiatrische Zentren) which offer interdisciplinary assessment and intervention for children and youth with developmental disorders, disabilities, and psychological problems. Large effects were found for clinical diagnoses and types of schooling that are related to intellectual abilities: Children with intellectual developmental disorders and pupils of special schools for children with intellectual disability obtained low or very low IQ-scores. Children with migration background scored relatively lower only on the Verbal Comprehension Index.
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19
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Shaw RJ, Rackley S, Walker A, Fuchs DC, Meadows A, Dalope K, Pao M. Core Competencies for Pediatric Consultation-Liaison Psychiatry in Child and Adolescent Psychiatry Fellowship Training. Psychosomatics 2019; 60:444-448. [PMID: 31248613 DOI: 10.1016/j.psym.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship. OBJECTIVE The objective of this project was to develop a national consensus on pediatric CLP competencies to help guide training in this specialty. METHODS An expert working group developed a list of candidate competences based on previously established educational outcomes for CLP (formerly Psychosomatic Medicine), child and adolescent psychiatry, and general psychiatry. A survey was distributed to members of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee to determine child and adolescent psychiatry fellowship educational needs on pediatric CLP services and generate consensus regarding pediatric CLP competencies. RESULTS Most survey respondents were supportive of the need for a national consensus on core competencies for pediatric CLP. Consensus from a panel of experts in the field of pediatric CLP generated a list of proposed core competencies that track the Accreditation Council for Graduate Medical Education's six core competencies. CONCLUSIONS Consistent learning outcomes provide the foundation for further development of tools to support training in pediatric CLP. There is a need to develop further tools including outcome assessment instruments and self-directed learning materials that can be used to support lifelong learning.
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Affiliation(s)
- Richard J Shaw
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, Palo Alto, CA.
| | - Sandra Rackley
- Division of Child and Adolescent Psychiatry, Mayo Clinic, Rochester, MN
| | - Audrey Walker
- Office of Residency Training in Psychiatry, Bronx, NY; Division of Child and Adolescent Psychiatry, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - D Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Amy Meadows
- Departments of Psychiatry and Pediatrics, University of Kentucky College of Medicine, Lexington, KY
| | - Kristin Dalope
- Department of Psychiatry and Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
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20
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McGrady ME, Peugh JL, Brown GA, Pai ALH. Spending on Hospital Care and Pediatric Psychology Service Use Among Adolescents and Young Adults With Cancer. J Pediatr Psychol 2018; 42:1065-1074. [PMID: 28339812 DOI: 10.1093/jpepsy/jsx001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the relationship between need-based pediatric psychology service use and spending on hospital care among adolescents and young adults (AYAs) with cancer. Methods Billing data were obtained from 48 AYAs with cancer receiving need-based pediatric psychology services and a comparison cohort of 48 AYAs with cancer not receiving services. A factorial analysis of covariance examined group differences in spending for hospital care. Pending significant findings, a multivariate analysis of covariance was planned to examine the relationship between need-based pediatric psychology service use and spending for inpatient admissions, emergency department (ED) visits, and outpatient visits. Results Spending for hospital care was higher among AYAs receiving need-based pediatric psychology services than in the comparison cohort (p < .001, ωPartial2 = .11). Group differences were driven by significantly higher spending for inpatient admissions and ED visits among AYAs receiving need-based pediatric psychology services. Conclusions The behavioral and psychosocial difficulties warranting need-based pediatric psychology services may predict higher health care spending.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology
| | - Gabriella A Brown
- Division of Behavioral Medicine and Clinical Psychology.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
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21
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Weissberg-Benchell J, Rychlik K. Diabetes camp matters: Assessing families' views of their diabetes camp experience. Pediatr Diabetes 2017; 18:853-860. [PMID: 28156056 DOI: 10.1111/pedi.12499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Camp offers a safe and fun environment for learning new information about diabetes care and for trying new self-care skills. It is a place where children and teens are able to meet with others who also have diabetes and who share their experiences. MATERIALS AND METHODS This study assessed self-reports before and after attending diabetes camp on diabetes-specific emotional distress, diabetes-specific quality of life, and self-care behaviors by surveying campers and their parents from over 42 diabetes-specific summer camps across the United States. Parents (N = 413), Teenagers (N = 154), and Children (N = 116) completed both pre- and post-camp surveys. RESULTS Parents reported higher levels of diabetes-specific emotional distress than their campers did. Both parents and children reported significant improvements in their own distress after camp. Teens reported improvements in distress but they were not statistically significant. Youth report higher levels of self-care skills than parents believe their children possess. Parents, Teens, and Children all reported significant improvements in the camper's self-care skills after camp. First time campers' and their parents' perspectives regarding self-care skills are consistent with veteran campers after attending camp. Self-reports post-camp reveals that campers and their parents see camp as a place where youth feel they are with others who really understand what it is like to live with diabetes. Respondents also report that camp is a place where youth are exposed to new technologies and where campers can try new self-care tasks.
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Affiliation(s)
- Jill Weissberg-Benchell
- Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Karen Rychlik
- Stanley Manne Children's Research Institute, Statistics Core, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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22
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Abstract
Children and adolescents who require limb amputation as part of cancer treatment face many physical and emotional challenges. Preparatory interventions may serve to facilitate positive coping and improve long-term adjustment during pediatric cancer treatment, including decreasing anxiety and postoperative distress. This review aimed to examine and identify the type and degree of psychosocial preparation provided to the child with cancer and family prior to amputation. Electronic databases including Embase, PubMed, and PsycINFO were searched for relevant research articles. Five studies were identified that satisfied inclusion criteria and revealed common themes for preparatory interventions, but results were limited by a lack of empirical approaches and revealed little consensus on pre-operative support prior to amputation. These findings demonstrate that there is a lack of studies to date that have adequately addressed psychosocial preparation prior to amputation for pediatric oncology patients. Future research on preparatory interventions is needed using prospective and quantitative research to establish evidence-based recommendations for interventions to support this vulnerable population.
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Affiliation(s)
- Caitlyn A. Loucas
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center; Boston, MA
| | - Sarah R. Brand
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center; Boston, MA
- Harvard Medical School; Boston, MA
| | | | - Anna C. Muriel
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center; Boston, MA
- Harvard Medical School; Boston, MA
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Abstract
Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment. Dexmedetomidine is likely the most appropriate preoperative anxiolytic as oral benzodiazepines are relatively contraindicated. Methohexital, though becoming less available at many institutions, remains the gold standard for induction of anesthesia for pediatric electroconvulsive therapy though ketamine, propofol, and sevoflurane are becoming increasingly viable options. Proper planning and communication between the multidisciplinary teams involved in the care of children presenting for electroconvulsive therapy treatments is vital to mitigating risks and achieving the greatest therapeutic benefit.
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Affiliation(s)
- Andrew D Franklin
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric T Stickles
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Wysocki T, Brosig CL, Hilliard ME. Society of Pediatric Psychology Workforce Survey: Development of Survey Methods, Sample Characteristics, and Lessons Learned. Clin Pract Pediatr Psychol 2017; 4:74-83. [PMID: 28066693 DOI: 10.1037/cpp0000134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are few detailed workforce studies of specialty fields within professional psychology, and none have been reported for pediatric psychology since 2006. Availability of such data could facilitate more-informed decision making by students and trainees, psychologists pursuing employment opportunities, and psychologists involved in employment or compensation negotiations. This article describes the work of a task force of the American Psychological Association (APA) Division 54 (Society of Pediatric Psychology) in the design, construction, pretesting, distribution, and data management for the Society of Pediatric Psychology (SPP) Workforce Survey. The 18-member task force was established to design and implement a workforce survey that balanced needs for breadth, clarity, brevity, and protection of confidentiality. The survey solicits information about demographic characteristics; training, licensure and certifications; employment settings, responsibilities, and productivity metrics; compensation; and employment satisfaction. A survey link was distributed via e-mail to full members of the SPP in June 2015. A total of 404 members (32.3% return rate) completed the survey. This article focuses on the development, methodology, and respondent characteristics for this 1st administration of the workforce survey. Separate articles will report detailed analyses of the survey results such as compensation and work satisfaction. Future distributions of the survey will enable compilation of a longitudinal database to track changes in the profession. SPP members and others may propose additional analyses of these data. This work may provide guidance to other groups of specialized psychologists who may wish to implement similar initiatives.
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Affiliation(s)
- Tim Wysocki
- Nemours Children's Health System, Jacksonville, Florida
| | - Cheryl L Brosig
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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25
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Welsh JS. Commentary: Are Children Like Werewolves? Full Moon and Its Association with Sleep and Activity Behaviors in an International Sample of Children. Front Pediatr 2016; 4:94. [PMID: 27629071 PMCID: PMC5006316 DOI: 10.3389/fped.2016.00094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/23/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- James S Welsh
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
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Marchak JG, Reed-Knight B, Amaral S, Mee L, Blount RL. Providers' assessment of transition readiness among adolescent and young adult kidney transplant recipients. Pediatr Transplant 2015; 19:849-57. [PMID: 26508553 DOI: 10.1111/petr.12615] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Abstract
The Readiness for Transition Questionnaire- provider version (RTQ-Provider) was developed to evaluate adolescent patients' transition readiness and healthcare behaviors from the perspective of the healthcare provider. The RTQ-Provider is a parallel version of the RTQ-Teen and RTQ-Parent completed by patients and parents. This study seeks to evaluate the psychometric properties of the RTQ-Provider and its utility as a clinical transition planning tool. Participants consisted of 49 kidney transplant recipients between the ages of 15 and 21. The RTQ-Provider was completed by the pediatric nephrologist and psychologist from the multidisciplinary healthcare team and compared to RTQ data from teens and parents. The RTQ-Provider demonstrated good-to-excellent internal consistency and interrater reliability. Construct validity was supported through significant predictive relationships between providers' perceptions of transition readiness and older patient age, increased patient healthcare responsibility, and decreased parent involvement in health care. By providing parallel teen, parent, and provider forms, the RTQ has the potential to foster open communication between patients, families, and healthcare team members regarding transition readiness. The study provides initial support for the RTQ-Provider as a clinical tool to assess providers' perceptions of transition readiness; however, future longitudinal research is needed to evaluate predictive validity following patients' transfer to adult care.
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Affiliation(s)
- Jordan Gilleland Marchak
- Aflac Cancer Center at Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Bonney Reed-Knight
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandra Amaral
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Mee
- Department of Transplant Services at Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Psychiatry, Emory School of Medicine, Atlanta, GA, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, Athens, GA, USA
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Ievers-Landis CE, Hazen RA, Fehr KK. Competencies in Training at the Graduate Student Level: Example of a Pediatric Psychology Seminar Course. Clin Pract Pediatr Psychol 2015; 3:197-204. [PMID: 26900536 DOI: 10.1037/cpp0000104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The recently developed competencies in pediatric psychology from the Society of Pediatric Psychology (SPP) Task Force on Competencies and Best Training Practices in Pediatric Psychology provide a benchmark to evaluate training program practices and student progress toward training in level-specific competency goals. Graduate-level training presents a unique challenge for addressing the breadth of competencies required in pediatric psychology while maintaining development of broader clinical psychology training goals. We describe a recurring graduate-level pediatric psychology seminar course that addresses training in a number of the competency cluster areas. The structure of the seminar, examples of classroom topics that correspond with competency cluster areas as well as benchmarks used to evaluate each student's development in the competency area are provided. Specific challenges in developing and maintaining the seminar in this format are identified, and possible solutions are offered. This training format could serve as a model for established pediatric psychology programs to expand their didactic training goals or for programs without formal pediatric psychology training to address competencies outside of clinical placements.
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Affiliation(s)
- Carolyn E Ievers-Landis
- Division of Developmental and Behavioral Pediatrics & Psychology, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center; Departments of Pediatrics and Psychological Sciences, Case Western Reserve University
| | - Rebecca A Hazen
- Division of Developmental and Behavioral Pediatrics & Psychology, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center; Departments of Pediatrics and Psychological Sciences, Case Western Reserve University
| | - Karla K Fehr
- Department of Psychology, Southern Illinois University, Carbondale
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Reed-Knight B, Lee JL, Cousins LA, Mee LL. Intellectual and academic performance in children undergoing solid organ pretransplant evaluation. Pediatr Transplant 2015; 19:229-34. [PMID: 25389073 DOI: 10.1111/petr.12389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 11/27/2022]
Abstract
Although prior research has shown lower intellectual functioning across pediatric solid organ transplant recipients relative to matched siblings or norm comparisons, few studies have assessed intellectual and academic performance prior to transplant across organ groups. The current data examine intellectual and academic functioning in children being evaluated for kidney, liver, or heart transplant. This investigation included intellectual and academic testing data from 195 children and adolescents between the ages of six and 19 yr evaluated for solid organ transplantation. Across organ groups, patients' intellectual functioning as estimated by the WASI/WASI-II at the time of pretransplant evaluation was within the average range, but lower compared to test norms. Patients demonstrated lower estimates of word reading, math computation, and spelling skills compared to the normal population, with the exception of heart patients' word reading and spelling skills and liver patients' spelling scores. Cognitive and academic impairments exist in children prior to transplantation. Findings emphasize the support that patients may require to manage the complicated medical regimen and succeed academically. Routine cognitive and academic assessment can inform healthcare providers regarding transplant patients' capacity to take on increasing medical responsibility and successfully reintegrate into the school environment.
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Affiliation(s)
- Bonney Reed-Knight
- Department of Transplant Services, Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
Millions of children undergo outpatient surgery in the United States each year; the overwhelming majority will experience significant perioperative anxiety and pain. Behavioral preparation programs focused on skills acquisition and modeling, considered essential for effective preparation, are no longer offered to most children and families in the outpatient surgery setting. Moreover, what little preparation does occur is typically generic in nature, rather than tailored to unique characteristics of the child and family. Untreated anxiety and pain have significant implications for children's short- and long-term recovery and future interactions in the medical environment. The rapid growth of the World Wide Web and increasing access to Internet by families across the country provide an opportunity to develop tailored, Web-based behavioral preparation programs that can be accessed repeatedly at times convenient to the child and family, that include coping skills training and modeling, and that can provide unique output based upon child and parent characteristics known to impact perioperative pain and anxiety. In this review article, we present a conceptual framework for a computer-based intervention that may transform the way we manage children and parents before and after surgery.
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Affiliation(s)
- Michelle A. Fortier
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Irvine/USA
,UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine/USA
| | - Zeev N. Kain
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Irvine/USA
,UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine/USA
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Genik LM, Yen J, McMurtry CM. Historical analysis in pediatric psychology: the influence of societal and professional conditions on two early pediatric psychology articles and the field's subsequent development. J Pediatr Psychol 2014; 40:167-74. [PMID: 25273000 DOI: 10.1093/jpepsy/jsu084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The field of pediatric psychology arose in the 1960s in response to a variety of societal and professional needs. 2 seminal articles written during this time, by Jerome Kagan (1965) and Logan Wright (1967), played key roles in the field's development. However, their efficacy in galvanizing a response from medical professionals and psychologists had much to do with broad-ranging developments in pediatric public health, intraprofessional changes among medical specialties, and a growing preoccupation with "psychosocial" and parenting issues. The purpose of this paper is to situate Kagan's (1965) and Wright's (1967) contributions within their social and historical contexts, and thereby to elicit reflection on the field's subsequent and continued development.
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Affiliation(s)
- Lara M Genik
- Department of Psychology, University of Guelph, Department of Pediatrics, Western University, and Children's Health Research Institute
| | - Jeffery Yen
- Department of Psychology, University of Guelph, Department of Pediatrics, Western University, and Children's Health Research Institute
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Department of Pediatrics, Western University, and Children's Health Research Institute Department of Psychology, University of Guelph, Department of Pediatrics, Western University, and Children's Health Research Institute Department of Psychology, University of Guelph, Department of Pediatrics, Western University, and Children's Health Research Institute
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Abstract
This introduction to the special issue on Evidence-Based Interventions in Pediatric Psychology provides background on the process used to develop the special issue, a summary of the key findings from the series of reviews, and discussion of the implications for evidence-based practice. Authors followed a three-phase approach to develop their systematic reviews using rigorous systematic review methodology drawn heavily from the Cochrane Collaboration. The strength of the evidence for each pediatric psychology intervention was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The introduction discusses the progress that has been made in the evidence base for pediatric psychology interventions since the first special series published in 1999. Recommendations to stimulate further research and expand and strengthen the quality of the evidence base are described. The introduction concludes with implications from the special issue for pediatric psychology training in evidence-based practice.
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Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children's Research Institute
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Palermo TM, Janicke DM, McQuaid EL, Mullins LL, Robins PM, Wu YP. Recommendations for training in pediatric psychology: defining core competencies across training levels. J Pediatr Psychol 2014; 39:965-84. [PMID: 24719239 DOI: 10.1093/jpepsy/jsu015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE As a field, pediatric psychology has focused considerable efforts on the education and training of students and practitioners. Alongside a broader movement toward competency attainment in professional psychology and within the health professions, the Society of Pediatric Psychology commissioned a Task Force to establish core competencies in pediatric psychology and address the need for contemporary training recommendations. METHODS The Task Force adapted the framework proposed by the Competency Benchmarks Work Group on preparing psychologists for health service practice and defined competencies applicable across training levels ranging from initial practicum training to entry into the professional workforce in pediatric psychology. RESULTS Competencies within 6 cluster areas, including science, professionalism, interpersonal, application, education, and systems, and 1 crosscutting cluster, crosscutting knowledge competencies in pediatric psychology, are presented in this report. CONCLUSIONS Recommendations for the use of, and the further refinement of, these suggested competencies are discussed.
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Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Department of Clinical and Health Psychology, University of Florida, Department of Psychiatry and Human Behavior, Brown University, Department of Psychology, Oklahoma State University, Department of Psychology, Children's Hospital of Philadelphia, and Department of Family and Preventive Medicine, University of Utah
| | - David M Janicke
- Department of Anesthesiology & Pain Medicine, University of Washington, Department of Clinical and Health Psychology, University of Florida, Department of Psychiatry and Human Behavior, Brown University, Department of Psychology, Oklahoma State University, Department of Psychology, Children's Hospital of Philadelphia, and Department of Family and Preventive Medicine, University of Utah
| | - Elizabeth L McQuaid
- Department of Anesthesiology & Pain Medicine, University of Washington, Department of Clinical and Health Psychology, University of Florida, Department of Psychiatry and Human Behavior, Brown University, Department of Psychology, Oklahoma State University, Department of Psychology, Children's Hospital of Philadelphia, and Department of Family and Preventive Medicine, University of Utah
| | - Larry L Mullins
- Department of Anesthesiology & Pain Medicine, University of Washington, Department of Clinical and Health Psychology, University of Florida, Department of Psychiatry and Human Behavior, Brown University, Department of Psychology, Oklahoma State University, Department of Psychology, Children's Hospital of Philadelphia, and Department of Family and Preventive Medicine, University of Utah
| | - Paul M Robins
- Department of Anesthesiology & Pain Medicine, University of Washington, Department of Clinical and Health Psychology, University of Florida, Department of Psychiatry and Human Behavior, Brown University, Department of Psychology, Oklahoma State University, Department of Psychology, Children's Hospital of Philadelphia, and Department of Family and Preventive Medicine, University of Utah
| | - Yelena P Wu
- Department of Anesthesiology & Pain Medicine, University of Washington, Department of Clinical and Health Psychology, University of Florida, Department of Psychiatry and Human Behavior, Brown University, Department of Psychology, Oklahoma State University, Department of Psychology, Children's Hospital of Philadelphia, and Department of Family and Preventive Medicine, University of Utah
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Ramsawh HJ, Chavira DA, Kanegaye JT, Ancoli-Israel S, Madati PJ, Stein MB. Screening for adolescent anxiety disorders in a pediatric emergency department. Pediatr Emerg Care 2012; 28:1041-7. [PMID: 23023473 DOI: 10.1097/PEC.0b013e31826cad6a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Adolescence is a time of increasing risk for some anxiety disorders. Scant data exist on adolescent anxiety in emergency department (ED) settings. We sought to characterize select clinical characteristics and health care use associated with anxiety disorders in a pediatric ED. METHODS We screened a convenience sample of 100 adolescent-parent dyads presenting to the ED for the presence of child anxiety disorders using the 5-item Screen for Child Anxiety Related Emotional Disorders, parent (SCARED-P) and child (SCARED-C) versions. Additional demographic and clinical data were also collected. RESULTS The SCARED-P and SCARED-C screens identified probable anxiety disorder(s) in 26% to 33% of adolescent participants, respectively. Correlates of positive SCARED-C screens were female sex, asthma, presenting complaint involving headache or migraine, and school absenteeism due to physical problems. Correlates of positive SCARED-P screens were lower parental educational level, presenting complaint involving headache or migraine, and more medical specialty and total medical visits. Few anxious adolescents had received mental health services in the past 6 months. In multivariate models, female sex was independently associated with SCARED-C total score, and presenting complaint involving headache or migraine was independently associated with SCARED-P total score. CONCLUSIONS The current pilot data suggest that anxiety disorders are more prevalent among adolescent ED patients than among the general population but largely untreated. Several demographic and clinical variables may help to identify occult anxiety disorders. Greater awareness of anxiety disorders in this population may assist in redirecting a pattern of low use of mental health services but higher overall health care use.
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Abstract
Several novel technologies have long been used in pediatric psychology. From using electronic pill-count bottles to track child adherence to pill-taking regimens to using bed alarms for night time enuresis, psychologists have relied on technology in their work with children who are ill. Much of the recent technology literature in pediatric psychology has focused on the use of the Internet and other Web-based technologies. This article thoroughly reviews the literature regarding telehealth in the field of pediatric psychology, more specifically the application of televideo or teleconferencing in various populations of children and adolescents with chronic illnesses, followed by the authors' clinical and research applications of telehealth in pediatric psychology. The review concludes with a summary of study findings and future directions in the field for clinicians and researchers alike.
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Affiliation(s)
- Jason Van Allen
- Student, Clinical Child Psychology Program, University of Kansas
| | - Ann McGrath Davis
- Associate Professor of Pediatrics, Behavioral Pediatrics Division, University of Kansas Medical Center
| | - Stephen Lassen
- Assistant Professor of Pediatrics, Behavioral Pediatrics Division, University of Kansas Medical Center
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Abstract
Research investigating the efficacy of infant massage has largely focused on premature and low birth weight infants. The majority of investigations have neglected highly acute patients in academic neonatal intensive care units (NICUs). The current study was developed with two aims: (Phase 1) to develop, implement and demonstrate the feasibility and safety of a parent-trained compassionate touch/massage program for infants with complex medical conditions and (Phase 2) to conduct a longitudinal randomized control trial (RCT) of hand containment/massage versus standard of care in a level III academic Center for Newborn and Infant Critical Care (CNICC). Certified infant massage instructors (CIMIs) taught parents to massage their hospitalized infants. Massage therapy and instruction were performed for seven consecutive days and health outcomes were collected for up to 1 month following treatment. Caregivers, nurses and certified infant massage therapists indicated moderate to high levels of satisfaction and feasibility with the implementation of hand containment/massage in a level III academic center CNICC. In addition, infant behavioral and physiological measures were within safe limits during the massage sessions. All caregivers participating in the massage group reported high levels of satisfaction 7 days into the intervention and at the 1-month follow-up with regards to their relationship with their infant, the massage program's impact on that relationship and the massage program. Due to unequal and small sample sizes, between group analyses (control versus massage) were not conducted. Descriptive infant characteristics of health outcomes are described. Preliminary data from this study indicates feasibility and safety of infant massage and satisfaction among the caregivers, CIMIs and the nurses in the CNICC. An important contribution from this study was the demonstration of the infants’ safety based on physiological stability and no change in agitation/pain scores of the infants receiving massage. Massage in a tertiary urban academic NICU continues to be an area of needed study. Future studies examining infant health outcomes, such as weight gain, decreased length of hospitalization and caregiver–infant bonding, would provide greater insight into the impact of massage for medically fragile infants.
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Affiliation(s)
- Karen Livingston
- Childrens Hospital Los Angeles, Rehabilitation Services, Integrative Touch for Kids, Childrens Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Comfort, Pain Management and Palliative Care Program and Keck School of Medicine, University of Southern California, USA
| | - Shay Beider
- Childrens Hospital Los Angeles, Rehabilitation Services, Integrative Touch for Kids, Childrens Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Comfort, Pain Management and Palliative Care Program and Keck School of Medicine, University of Southern California, USA
| | - Alexis J. Kant
- Childrens Hospital Los Angeles, Rehabilitation Services, Integrative Touch for Kids, Childrens Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Comfort, Pain Management and Palliative Care Program and Keck School of Medicine, University of Southern California, USA
| | - Constance C. Gallardo
- Childrens Hospital Los Angeles, Rehabilitation Services, Integrative Touch for Kids, Childrens Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Comfort, Pain Management and Palliative Care Program and Keck School of Medicine, University of Southern California, USA
| | - Michael H. Joseph
- Childrens Hospital Los Angeles, Rehabilitation Services, Integrative Touch for Kids, Childrens Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Comfort, Pain Management and Palliative Care Program and Keck School of Medicine, University of Southern California, USA
| | - Jeffrey I. Gold
- Childrens Hospital Los Angeles, Rehabilitation Services, Integrative Touch for Kids, Childrens Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Comfort, Pain Management and Palliative Care Program and Keck School of Medicine, University of Southern California, USA
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Abstract
Reviewed available studies of the impact of fetal cocaine exposure on child medical and developmental outcome, as well as the current status of clinical psychological interventions and research strategies. Current studies are inconclusive but suggest that prenatal exposure to crack-cocaine can have significant effects on the growth and neurological development of the infant, with the potential of later learning and behavioral disabilities. Social-environmental correlates of maternal cocaine use are confounding factors with known negative effects on child outcome. Large, population-based studies using multivariate analyses are needed to determine the independent effects of cocaine on child outcome relative to other confounding variables.
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Affiliation(s)
- L Singer
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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