Teachers' perceptions of and responses to adolescents with chronic pain syndromes

OBJECTIVE: To examine factors that influence teachers' perceptions of and responses to chronic pain in students. METHODS: Two-hundred and sixty classroom teachers responded to a vignette describing a student with limb pain. The 2 x 2 x 2 factorial design included conditions that varied by (a) the presence or absence of documented organic evidence for the pain, (b) cooperative vs. confrontational parent-teacher interactions, and (c) the presence or absence of communication from the medical team. Teachers rated pain severity and impairment, relief from classroom responsibilities, extent of accommodations the student would require in school, and sympathy for the student and family. RESULTS: Documented medical evidence supporting the pain was the most influential factor affecting teachers' responses to pain. Parental attitude also influenced responses. Communication from the medical team influenced teachers' decisions about relief from responsibilities but did not affect other reactions. CONCLUSIONS: Teachers' responses to students with pain are influenced by situational factors. Efforts to increase school functioning in youth with chronic pain should incorporate attempts to help teachers respond to pain adaptively.     

Children's Perceptions of Ill Peers as a Function of Illness Conceptualization and Attributions of Responsibility: AIDS as a Paradigm

Assessed the impact of developmental level of illness conceptualizationand degree of assigned responsibility on children's reactionsto ill peers. Accounts of hypothetical peers were manipulatedin a multivariate design with three levels of Disease Label(AIDS vs. cystic fibrosis vs. no label) and two levels of ResponsibilityInformation (low responsibility vs. no responsibility information),with the children's conceptualizations as a continuous variable.Subjects receiving information that the peer was not responsiblefor the illness tended to endorse higher ratings of acceptancethan those receiving no information about illness responsibility.Accounts of peers with AIDS resulted in lower ratings of acceptancethan those presented with accounts of peers with cystic fibrosisor an unlabeled illness. Subjects obtaining higher illness conceptualizationscores tended to perceive less vulnerability to casual contagion.     

A longitudinal examination predicting emergency room use in children with sickle cell disease and their caregivers

OBJECTIVE: To examine in a longitudinal investigation perceptions of disease severity among children and adolescents with sickle cell disease (SCD) and their caregivers and to determine whether perceptions of disease severity and self-reported adjustment would account for a greater percentage of the variance in emergency room (ER) use than objective measures of disease severity. METHODS: Participants were 58 African-American children (ages 8-18 years) diagnosed with SCD who were recruited from an outpatient clinic. Children and their caregivers were administered a series of measures designed to assess caregivers' adjustment and perceptions of children's disease severity. Frequency of ER visits was tabulated over an average 4-year period. RESULTS: Caregivers' and children's social adjustment accounted for a unique portion of the variance beyond that accounted by subjective perceptions of disease severity, demographic, and objective biological markers of disease severity. Poorer psychological adjustment of caregivers as well as communication patterns among children were associated with ER use frequency after controlling for objective disease severity variables and demographic factors. Child social adjustment, specifically friendship quality, accounted for variance in children's use of the ER beyond that accounted for by social class and objective markers of disease severity. CONCLUSIONS: Support is provided for the notion that ER use for children with SCD may be independent of disease severity and predicted by caregivers' psychological adjustment and children's peer adjustment.     

Social consequences of children's pain: when do they encourage symptom maintenance?

OBJECTIVE: To examine the influence of social factors (e.g., attention, relief from responsibility) and children's perceived competence on pediatric symptom maintenance. METHODS: Participants were 151 pediatric patients (ages 8-18) with recurrent abdominal pain. They were interviewed at a clinic visit and again 2 weeks later. The Social Consequences of Pain questionnaire assessed four types of social consequences: positive attention, negative attention, activity restriction, and privileges. RESULTS: Two types of social consequences (positive attention and activity restriction) predicted greater symptom maintenance, but this effect was moderated by children's perceived self-worth and academic competence. To the extent that children rated their self-worth and academic competence as low, the impact of social factors on symptom maintenance was stronger. CONCLUSIONS: Children's success in their normal social roles may affect the extent to which they identify with the sick role and find it a rewarding alternative to other social roles.     

Parental response to child illness behavior.

Examined the effects of child age and gender, parent gender, and type of child illness on parents' responses to their children's illness behavior. Study 1 describes the development of the Illness Behavior Encouragement Scale, based on Whitehead et al.'s Social Learning Scales for adults, and provides evidence supporting symptom specificity in children's learning of illness behavior. Results of Study 2 indicate that mothers encourage children's illness behavior more than fathers, that parents encourage children to adopt the sick role for gastrointestinal symptoms more than for cold symptoms, and that girls perceive parents as encouraging their illness behavior more than boys, that is, girls report receiving more sympathy and being allowed more relief from responsibility during illness episodes than boys.     

Factors influencing mother-child reports of depressive symptoms and agreement among clinically referred depressed youngsters in Hungary

BACKGROUND: Psychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers' and children's report of children's depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female. METHODS: Subjects were 354 children (158 girls; mean age 11.69 years, SD: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms. RESULTS: Maternal reports were significantly higher than their son's but not daughters'. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers' reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older. LIMITATIONS: The same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation. CONCLUSION: During a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child.     

Social Competence in Children with IDDM and Asthma: Child, Teacher, and Parent Reports of Children's Social Adjustment, Social Performance, and Social Skills

Used Cavell's (1990) model of childhood social competence tocompare the social competence in peer relations of 25 children(ages 8–10 years) with insulin-dependent diabetes mellitus(IDDM), 19 children with asthma, and 24 physically healthy children.Children were individually matched for economic status, race,gender, and age. Children, their parents, and their teacherscompleted measures of children's social adjustment, social performance,and social skills in peer relations. Contrary to hypotheses,no differences between the groups of children were noted onany of the measures of social competence. Results are discussedin terms of the resiliency of children's social competence tothese chronic conditions.     

Association With Deviant Peers Across Adolescence: Subtypes,Developmental Patterns,and Long-Term Outcomes

Indices of deviant peer group involvement are inconsistent and confound type, frequency, and severity of deviant peer behaviors. These measurement approaches thus obfuscate potential meaningful differences in deviant peer involvement in terms of subtypes, developmental patterns, and long-term outcomes. The current study employed latent class analysis to derive subtypes of deviant peer involvement and examined relations to substance use disorder in adulthood, a common outcome of deviant peer involvement. Youth (76% Caucasian) completed assessments across four time points: ages 10–12 years (Time 1; N = 775, 71% male), 12–14 years (Time 2; n = 649, 72% male), 16 years (Time 3; n = 613, 73% male), and 22 years (Time 4; n = 425, 71% male). At Times 1 to 3, participants completed an interview assessing deviant peer involvement. At Time 4, participants completed a structured interview assessing substance use disorder. Classes of youth with different profiles of deviant peer associations were derived at Times 1, 2, and 3. Classes varied by type (conduct problems vs. substance use) and severity of deviant peer behavior. Youth reported higher levels of involvement with deviant peers across adolescence, suggesting that some of these deviant peer behaviors may be normative. Earlier involvement with deviant peers and involvement with groups defined by severe conduct problems and substance use were related to the greatest risk for substance use disorder at Time 4. Type and severity of peer deviant behavior differentially relate to long-term risk for substance use disorder and should be included in screening and assessment for risk across adolescence.     

Peer rejection, temperament, and cortisol activity in preschoolers

In this study, we examined a model that describes both direct and indirect pathways between children's temperament and activity of the hypothalamic-pituitary-adrenal (HPA) axis when children are in peer-group settings. We hypothesize that in peer-group settings both shy, inhibited and exuberant, undercontrolled children would exhibit higher cortisol levels, but these associations would operate through different pathways. Sociometric measures of peer rejection, salivary cortisol, and teacher reports of temperament were collected on 82 preschoolers. Children who were rejected by classmates had higher cortisol levels than the other children. The combination of Surgency and Poor Effortful Control (Effortful Control, reverse scored) was associated with elevated cortisol through a pathway mediated by aggressive interactions with peers and peer rejection. With the indirect path explained, the combination of Surgency and Poor Effortful Control also was directly and negatively associated with classroom cortisol levels. These results help explain why temperament associations with HPA activity have been variable and difficult to discern when children are assessed in peer-group contexts. In these contexts, both direct and indirect pathways between temperament and cortisol need to be examined.     

The quality of peer relationships among children exposed to family violence

Three hundred sixty-three school-aged children from maritally violent and nonviolent families were interviewed about their friendship networks, frequency of social contact, the interpersonal quality of their friendships, and hostile attributional biases. Mothers answered items from the Child Behavior Checklist about peer conflict. Children did not differ on the number of friends they claimed or their frequency of contact with peers. However, children exposed to marital violence reported feeling more lonely and having more conflict with a close friend. Their mothers also reported them as having more problems with peers. In addition, children with punitive mothers had more conflict with a best friend. Residing in a shelter added further to children's feelings of loneliness, with one third having no best friend. Children's attributional biases were unrelated to the quality of their peer relations or any other index of peer functioning. Results are discussed in terms of an attachment framework. Findings confirm that it is important to examine the quality of relationships to determine how children at risk fare in their social lives.     

Perceived Peer Victimization Predicts Anxiety Outcomes in a Prevention Program for Offspring of Anxious Parents

Offspring of anxious parents are at heightened risk for developing anxiety disorders. Preventive interventions for these youths are promising but not universally effective, creating a need to identify outcome predictors. Peer experiences (e.g., peer victimization, social support) are associated with youth anxiety trajectories but have been relatively unexplored in this context. Thus, this study tested whether peer experiences predicted anxiety-related outcomes in families participating in a randomized controlled trial of a child anxiety prevention program for families with a clinically anxious parent. Parental anxiety severity was also examined as a moderator of relations between peer experiences and subsequent child anxiety. Participants were 121 families (child M age = 8.69, 55.90% girls). Hierarchical logistic and linear regressions were used to test whether baseline peer-related factors predicted increased anxiety symptom severity and anxiety disorder onset over 12 months. Youths reporting greater perceived peer victimization at baseline were more likely to develop an anxiety disorder and had more severe anxiety symptoms 12 months later. Lower social support from classmates also predicted increased anxiety severity, but this effect became nonsignificant after accounting for peer victimization. Further, parental anxiety severity moderated the peer victimization–child anxiety severity link: Higher child-reported peer victimization predicted increased anxiety in offspring of highly and moderately anxious but not low anxious parents. Children’s reports of peer victimization appear important for understanding which youth may not respond to preventive interventions in high-risk families—especially for children with more severely anxious parents. Implications for the focus of selective anxiety prevention programs are discussed.     

MP‐AzeFlu is more effective than fluticasone propionate for the treatment of allergic rhinitis in children

The objective was to evaluate the efficacy of MP‐AzeFlu (Dymista^®) vs fluticasone propionate (FP), (both 1 spray/nostril bid), in children with allergic rhinitis (AR). MP‐AzeFlu combines azelastine hydrochloride, FP and a novel formulation in a single spray. Children were randomized in a 3 : 1 ratio to MP‐AzeFlu or FP in this open‐label, 3‐month study. Efficacy was assessed in children aged ≥ 6 to <12 years (MP‐AzeFlu: n = 264; FP: n = 89), using a 4‐point symptom severity rating scale from 0 to 3 (0 = no symptoms; 3 = severe symptoms). Over the 3‐month period, MP‐AzeFlu‐treated children experienced significantly greater symptom relief than FP‐treated children (Diff: ?0.14; 95% CI: ?0.28, ?0.01; P = 0.04), noted from the first day (particularly the first 7 days) and sustained for 90 days. More MP‐AzeFlu children achieved symptom‐free or mild symptom severity status, and did so up to 16 days faster than FP. MP‐AzeFlu provides significantly greater, more rapid and clinically relevant symptom relief than FP in children with AR.     

Children's attitudes and behavioral intentions toward a peer presented as obese: does a medical explanation for the obesity make a difference?

OBJECTIVE: To examine the effect of information on children's attitudes and behavioral intentions toward a peer presented as obese. METHODS: Children (N = 184) were randomly assigned to observe a video of a boy or girl in one of three conditions: average-weight, obese, obese with medical information explaining the obesity. They rated stereotypical attitudes on the Adjective Checklist and behavioral intentions on the Shared Activities Questionnaire (SAQ-B). RESULTS: Ratings were generally more favorable for the average-weight than for the obese condition. However, provision of medical information had a positive effect on attitudes toward the obese peer only for younger children and a negative effect on willingness of older children to share academic activities with the peer. Boys and girls showed more positive behavioral intentions toward the same-sex target child regardless of obesity condition. CONCLUSIONS: Information explaining obesity has a minimal positive effect on children's attitudes and behavioral intentions toward a peer presented as obese.     

Work family balance, stress, and salivary cortisol in men and women academic physicians

Background: The stress of medical practice has been recurrently studied, but work- and family-related determinants of health by gender remain under researched. Purpose: To test the hypothesis that cortisol excretion would be affected by the perceived severity of total workload imbalance. Method: By hierarchical regression analysis, the associations between work-family balance and diurnal salivary cortisol levels by sex in academic physicians (n = 40) were investigated. Results: Men physicians reported more paid work hours per week than women physicians and women more time in childcare, but their total working hours were similar. Controlling for sex and age, the mean of the diurnal cortisol release was associated with a combined effect of sex and responsibility at home. When morning cortisol, sex, and children at home were held constant, cortisol levels in the evening were associated with responsibility at home without significant gender interaction. Conclusion: With increasing responsibility at home, women and men reacted differently with regard to cortisol responses over the day. However, in the evening, controlling for the morning cortisol, these gender differences were not as obvious. These findings highlight traditional gender patterns among both women and men physicians in the challenge of finding a balance between work and family.     

Overt and relational victimization among children with frequent abdominal pain: links to social skills, academic functioning, and health service use

OBJECTIVES: Chronic abdominal pain is linked with school absenteeism and diminished social competence; yet, little is know about the extent to which negative peer encounters contribute to symptoms and functioning in youth with abdominal pain. This study compared children with frequent abdominal pain with a pain-free control group on measures of overt and relational victimization and examined the link between abdominal pain and school-related functioning. METHODS: Participants were 60 children with frequent abdominal pain and 60 gender- and age-matched peers. Child, peer, and teacher reports were used to assess abdominal pain, peer victimization, use of school medical services, social skills, and academic competence. RESULTS: Children with frequent abdominal pain experienced higher levels of victimization than their pain-free peers, with boys in the pain group rated highest in overt victimization. For children in the pain group, overt and relational victimization made incremental contributions to outcomes and moderated the link between pain- and school-related functioning. CONCLUSIONS: Overt and relational victimization may increase risk of concurrent adjustment problems among youth with frequent abdominal pain; thus, it may be useful to assess peer relationships when working with this population.     

Parental reinforcement of recurrent pain: the moderating impact of child depression and anxiety on functional disability

OBJECTIVE: To examine whether children's distress moderates the relationship between parental responses to children's pain behaviors and functional disability. METHODS: Participants were 215 children (ages 8 to 16 years) diagnosed with either headaches, juvenile idiopathic arthritis, or sickle cell disease. Children and parents completed questionnaires assessing sociodemographics, pain, depression, anxiety, parental solicitous responses to pain behaviors, and functional disability. RESULTS: Hierarchical linear regressions computed for parental responses to children's pain significantly predicted child functional disability, controlling for children's pain intensity. Significant interactions between parental solicitous behaviors and child depressive symptoms (beta =.74, p <.01) and between solicitous behaviors and child anxiety symptoms (beta =.91, p <.01) indicated that for children with more psychological distress, parental solicitous behaviors were associated with greater child functional disability. CONCLUSIONS: Child psychological distress may exacerbate the impact of parental solicitous responses to pain on functioning, suggesting the potential role of family intervention to enhance optimal functioning in children with recurrent pain.     

The influence of parental distress on child depressive symptoms in juvenile rheumatic diseases: the moderating effect of illness intrusiveness

OBJECTIVE: To examine the role of children's illness-related cognitive appraisals in the parent-child adjustment relationship in a sample of children and adolescents with juvenile rheumatic disease (JRD). Specifically, we tested the moderating effect of children's perceived illness-induced barriers (i.e., illness intrusiveness) in the parent distress-child depressive symptom relationship. METHODS: Participants were 45 children and adolescents (ages 9-17) diagnosed with JRD. Children completed measures of depressive symptoms (Children's Depression Inventory), functional disability (Juvenile Arthritis and Functional Assessment Report), and illness intrusiveness (Illness Intrusiveness Scale-adapted for children); parents completed a brief measure of global distress (Brief Symptom Inventory). The pediatric rheumatologist provided functional disability ratings following a routine physical exam. RESULTS: Both increased parental distress and child illness intrusiveness were associated with greater child depressive symptoms. Direct effects were qualified by a significant Parent Distress x Illness Intrusiveness interaction. The influence of general parental distress on child depressive symptoms was enhanced under conditions of increased child-reported illness intrusiveness. CONCLUSIONS: Results support transactional conceptualizations of child adjustment to chronic illness. Findings also emphasize the need to examine the interaction of parent and child variables, particularly cognitive appraisals, in child adjustment. Results and treatment implications for children with JRD are discussed in terms of reinforcement theories of depression.     

Cross-situational patterns in children's coping with observed interpersonal conflict

Investigated cross-situational patterns in children's coping with observed interpersonal conflict. Children in Grades 4, 5, 7, and 8 (N = 417) reported on their use of five coping responses when exposed to conflict they observed between the adults in their homes and between their peers. Although children reported using the same relative pattern of coping responses across situations (i.e., distancing/denial the most, support seeking the least), they used a much higher level of internalizing/worrying responses when exposed to the adult conflict situation than the peer conflict situation. Sex and developmental differences were not consistent across observed interpersonal conflict situations.     

Peer influence on children's physical activity: an experience sampling study

OBJECTIVE: The primary objective was to examine the associations between social context (the presence of peers, friends, and family members) and physical activity intensity for overweight and lean girls and boys. METHODS: Participants for this study included 10 boys (M = 13.4 years; SD = .8) and 10 girls (M = 13.8 years; SD =. 8). Twelve participants were between the 15th and the 85th BMI percentile (eight girls, four boys) and eight youth were at or above the 85th BMI percentile (six boys, two girls). Participants reported on their activity intensity and whether the activity was solitary or with others for seven consecutive days. RESULTS: Children were more likely to report more intense physical activity when in the company of peers or close friends. Overweight children reported greater physical activity when in the presence of peers than did lean children; however, overweight children also reported more time spent alone. CONCLUSIONS: Taken together, findings highlight the importance of considering peer relationships in studies of physical activity and childhood "obesity".