Assessing pain in patients with severe cerebral palsy: development, reliability, and validity of a pain assessment instrument for cerebral palsy

OBJECTIVES: To develop the Pain Assessment Instrument for Cerebral Palsy (PAICP) and to study its test-retest reproducibility and construct validity. DESIGN: Cross-sectional validation study. SETTING: Homes for severely handicapped. PARTICIPANTS: A total of 164 adults with severe cerebral palsy (CP), caregivers, and physiotherapists, and 9 healthy children. INTERVENTIONS: The PAICP contains drawings of situations, some situations of which usually produce pain. Patients rate the pain associated with each activity using a Faces Pain Scale. Reproducibility and construct validity was assessed in a pilot study with CP patients and healthy children. Construct validity and agreement between the pain scores of the patients and proxies was assessed in 160 patients with severe CP. MAIN OUTCOME MEASURE: Pain score on the PAICP. RESULTS: The measure showed adequate test-retest reproducibility. A significant difference was found between the mean scores for "painful" and "not painful" situations. We also found moderate agreement between the scores of the patients and proxies for daily activities but only for those activities in which the proxies were personally involved. CONCLUSIONS: The PAICP has adequate test-retest reproducibility and construct validity. It provides an indication of the pain experienced by patients in situations in which proxies are not personally involved and may also be more valid than proxy measures for other situations.     

农村与城市儿童个性行为特征对比研究

目的探讨农村与城市儿童的个性行为特征。方法对90名农村儿童和90名城市儿童采用艾森克个性问卷测评个性,采用儿童行为量表评定行为特征,并进行对比分析。结果农村组儿童与城市组儿童艾森克个性问卷各项因子分均无显著性差异;儿童行为量表评定结果显示,农村组女童退缩、社交因子分与男童违纪、攻击和外向因子分显著高于城市组,差异显著(P<0.05)。结论农村儿童行为问题较突出,女童主要表现为社交困难、孤僻退缩,男童主要为外向、违纪和攻击行为等。这些问题可能与其不同的生活方式、文化教养有关。     

Patterns of grief in young children following the death of a sibling

Specific grief behaviors observed in children ages 4-16 years in the 2 years after the death of a sibling are reported. Using the Child Behavior Checklist (CBCL), the parents of 90 boys and girls rated the occurrence of behavior problems in their children. Behavior problems identified in 50% or more of the children are reported both for the total sample and by age and sex groups. The behaviors commonly observed in the bereaved children predominanty fell into the Agression subscale of the standardized CBCL. It is suggested that bereaved children use aggressive behaviors instrumentally to gain parental attention, rather than as an instinctual expression of hostility and anger.     

认知疗法在改善学龄期白血病患儿心理行为中的应用

目的探讨认知疗法在改善学龄期白血病患儿心理行为中的应用方法和效果。方法采用儿童行为评定量表（Achenbach,s Child Behavior Checklist,CBCL）对88例白血病患儿心理行为进行调查;并对行为异常的患儿实施认知疗法的干预．比较干预前后患儿CBCL测评结果。结果学龄期白血病男性患儿与女性患儿的心理行为得分超出正常值上限的分别为25．00％和22．92％,显著高于常模的12．93％（P〈0．05）。干预前后男性患儿在活动能力、社交能力、学校能力、社会能力、分裂样、抑郁、社会不良、躯体诉述、攻击性行为因子及行为问题总分比较,差异具有统计学意义（均P〈0．05）。干预前后女性患儿在社会能力、抑郁、社会退缩、躯体诉述、分裂样、多动因子及行为问题总分比较,差异具有统计学意义（均P〈0．05）。结论认知行为疗法可改善学龄期白血病患儿的心理行为。     

Behaviour among children of substance‐abusing women attending a Special Child Welfare Clinic in Norway,as assessed by Child Behavior Checklist (CBCL)

Scand J Caring Sci; 2013; 27; 285–294 Behaviour among children of substance‐abusing women attending a Special Child Welfare Clinic in Norway, as assessed by Child Behavior Checklist (CBCL) Background: A Special Child Welfare Clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems. Treatment is given without substitution. This investigation assesses the behaviour of the children between the ages 6 and 13 years of women who attended the clinic. It also explores the correlation between the behaviour and a neuropsychological screening performed one and a half year earlier. The study was set up to investigate the influence of prenatal substance exposure. Method: Thirty‐eight SCWC children and 63 children in a comparison group were scored by Child Behavior Check List (CBCL). Twenty‐one (55%) SCWC mothers were classed as short‐term users (ceased substance abuse before the end of first trimester), and 17 (45%) were classed as long‐term users (continued a moderate substance abuse throughout pregnancy). Thirteen (77%) of the children of the long‐term users were living in foster homes at the time of the investigation. Results: SCWC children were scored within normal ranges for most items, but their scores were significantly worse than those of the comparison group. Children of short‐term users were given lower scores than comparisons on more issues in CBCL than were children of long‐term users. The SCWC children were breastfed for a shorter time (p = 0.023) and had moved house more often (p < 0.001) than comparisons. SCWC children living with their biological mothers received more special education or remedial classes (p ≤ 0.001) than children of the comparisons. Conclusion: Most children of long‐term users were living in foster homes. Notably, children of short‐term users, that is, children living with their biological mothers, were given lower scores than comparisons in CBCL. Children of short‐term users were more likely to receive special education than children of comparisons. More research is needed on how to reveal parenting problems and how to guide mothers with previous or present substance abuse problems.     

Evaluating pain in cerebral palsy: comparing assessment tools using the International Classification of Functioning,Disability and Health

Abstract

Purpose: Pain is prevalent and affects functioning and quality of life of children with cerebral palsy (CP). However, pain in CP is under recognized. The International Classification of Functioning, Disabiity and Health (ICF) guides the selection of comprehensive chronic pain assessment tools. Our objectives were to identify measures addressing pain in children with CP, characterize the content of each measure using the ICF, and identify gaps and overlaps.

Materials and methods: Measures were identified from: (1) a systematic review of outcome measures (1998–2012) and (2) a scan of chronic pain measures (2013–2015). Included measures were those published in English, used in children and youth with CP, and contained an item/domain addressing pain. Constructs of the measures were linked to the ICF.

Results: Overall, 31 measures addressing chronic pain in CP were included. Considerable variability was found in the degree to which their content represented the ICF. Most of pain measures address pain intensity and pain location (body functions) as opposed to functional impact of pain (activities and participation).

Conclusions: Functional dimensions are poorly represented in pain measures. Our findings may guide the selection of measures for research and clinical needs for comprehensive chronic pain management in children with CP.

• Implications for Rehabilitation

• Chronic pain is prevalent among children with cerebral palsy and significantly interfere with functional activities.

• To effectively manage chronic pain in children with cerebral palsy, measures capturing functional-based information need to be part of routine chronic pain assessment.

     

Pain in children with cerebral palsy: a review.

Children with cerebral palsy (CP) face many challenges including impaired motor control and coordination, functional impairment, sensory disturbances, and, sometimes, communication difficulties and cognitive deficits. Pain also may be a problem for children with CP due in part to the inherent deficits associated with the disease, as well as the invasive medical and surgical procedures and rehabilitative activities children with CP undergo on a regular basis. A review of current literature indicates pain is a common experience for children with CP and has been understudied in this population. Further emphasis and research on appropriate assessment and management strategies sensitive to the unique characteristics and limitations of children with CP are warranted.     

抽动障碍儿童141例行为特征的研究

目的 对抽动障碍(TD)患儿行为特征进行全面研究,完善TD诊疗方案,提供新的诊疗思路.方法 本课题采用Achenbach儿童行为量表(CBCL)对明确诊断为TD的患儿进行行为特征研究.结果 行为特征研究发现,TD男童与正常儿童行为因子相比均有显著差异(P<0.01).从4~16岁,TD男童的外向性评分逐渐高于内向性评分;TD女童则除性问题、违纪、残忍因子外与正常儿童相比差异均有统计学意义(P<0.01),且内向性评分明显高于外向性评分.结论 TD患儿具有广泛的行为问题,男童以外向行为为主,而女童则以内向行为为主.     

The Pediatric Quality of Life Inventory: an evaluation of its reliability and validity for children with traumatic brain injury

OBJECTIVES: To assess the reliability and validity of the Pediatric Quality of Life Inventory, version 4.0 (PedsQL), and to compare it with that of the Behavior Rating Inventory of Executive Function (BRIEF) among children with traumatic brain injury (TBI). DESIGN: Prospective cohort study that documented the health-related quality of life of 391 children at 3 and 12 months postinjury. SETTING: Four level I pediatric trauma centers. PARTICIPANTS: Children (age range, 5-15 y) hospitalized with a TBI or an extremity fracture. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Parent-reported PedsQL and BRIEF scale scores. RESULTS: Both the PedsQL and BRIEF scales showed good internal consistency (PedsQL alpha range, .74-.93; BRIEF alpha range, .82-.98) and test-retest reliability (PedsQL r range, .75-.90; BRIEF r range, .82-.92), respectively. Factor analysis revealed that most PedsQL items loaded most highly on their conceptually derived scale. The PedsQL cognitive function scale detected the largest differences among groups of children with varying severities of TBI as well as parents' assessment of change in cognition postinjury. CONCLUSIONS: Although the reliability of the 2 instruments is comparable, the PedsQL discriminates better among children with TBI. The PedsQL is a promising instrument for measuring the health of children after TBI.     

The Mental Health of Homeless School-Age Children

PROBLEM: The mental health of homeless school-age children. METHODS: A convenience sample of 46 homeless children between the ages of 8 and 12 years completed the Children's Depression Inventory (CDI) and each child's mother completed the Child Behavior Checklist (CBCL). FINDINGS: Fifty-seven percent of the children had depressive symptoms and 26% needed additional evaluation for mental health problems. Overall, the CDI and CBCL scores indicated that gender or ethnicity are not related to the children's mental health. CONCLUSIONS: The mental health of homeless schoolage children should be assessed, as they may be at risk for mental health problems.     

注意力缺陷多动障碍儿童的智力和行为特点

目的：探讨注意力缺陷多动障碍（ADHD）儿童的智力水平、智力结构及行为特点。方法：对ADHD儿童组及正常儿童组用韦氏儿童智力量表（WISC-CR）及Achenbach儿童行为量表（CBCL）进行智力和行为测定,并对智力和行为测定的结果进行比较分析。结果：ADHD儿童的智力水平、总智商（FIQ）、言语智商（VIQ）及操作智商（PIQ）均明显低于正常儿童组,两组比较差异有统计学意义。在各项分测验中,除译码外,其他9项分测验差异均有统计学意义。两组儿童VIQ〈PIQ1个标准差（15分）所占人数比较,差异具有显著性。提示ADHD儿童存在智力结构发展的不平衡。两组儿童行为测试结果比较分析,显示ADHD儿童内向分、外向分及行为总分均明显高于正常儿童组,两组比较差异均有统计学意义。在各项分测验中,除体诉外,其他8项分测验差异均有统计学意义。结论：ADHD儿童同正常儿童相比智力水平较低,智力结构发展不平衡,还具有许多行为和情绪问题。     

家庭环境与对立违抗性障碍儿童行为的相关性分析

【目的】探讨对立违抗性障碍(ODD)儿童的家庭环境特点及其与儿童行为的相关性。【方法】选用Achenbach儿童行为量表(CBCL)、家庭环境量表中文版(FES-CV)分别对75例ODD及75例正常儿童进行评定。【结果】ODD儿童的社会能力各分量表分及总分均显著低于对照组(P<0.01),行为问题各分量表分及总分高于对照组(P<0.01);ODD儿童的家庭在FES-CV量表中亲密度、情感表达、组织性的评分低于对照组(P<0.05),矛盾性则显著高于对照组(P<0.01)。FES-CV的某些维度与ODD儿童的行为特点存在不同程度的相关性。【结论】ODD儿童处在相对不良的家庭环境中,家庭环境对ODD儿童行为产生不良影响。     

Severity of violence against women correlates with behavioral problems in their children

In order to examine the type and severity of violence against women by intimate partners and the associated behavioral problems of their children, 83 abused women were interviewed when they presented to the criminal justice system for protective orders or to file assault charges. Two questionnaires were administered: (a) the 46-item Severity of Violence Against Women Scale (SVAWS) measured threats of abuse and actual physical violence, and (b) the 118-item Child Behavior Checklist (CBCL) measured child behavior problems for children between the ages of 4 and 18.     

The reliability and validity of pain interference measures in persons with cerebral palsy

OBJECTIVE: To evaluate the reliability and validity of 2 measures of pain interference in persons with cerebral palsy (CP). DESIGN: Standardized interviews to assess pain and impact of pain on activities. SETTING: University medical center. PARTICIPANTS: Fifty adults with CP. INTERVENTIONS: Patients asked to rate pain's intensity, interference with general activities, and depression levels. MAIN OUTCOME MEASURES: Pain interference scales: Chronic Pain Grade (CPG) and Brief Pain Inventory (BPI); rating of disability: Craig Handicap Assessment and Reporting Technique (CHART); rating of depression: Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS: Mean interference of pain on 3 CPG items (pain interference with daily activities, social activities, work) were 1.74 +/- 2.45, 1.06 +/- 2.05, and.89 +/- 1.84 (out of 10), respectively. Mean interference on 10 modified BPI interference items ranged from 2.28 +/- 3.01 to 3.67 +/- 3.15 (out of 10). The composite CPG interference score did not correlate significantly with pain intensity. However, the composite BPI interference score did correlate significantly with pain intensity (r = .66, P < .01). There was no significant association shown between average pain and the CHART score (r = -.21, NS). Pain showed a significant association with CES-D score (r = .45, P < .05). Internal consistency of the 3 CPG items was inadequately low (Cronbach alpha = .59), whereas that of the 10 BPI items was excellent (.89). CONCLUSIONS: The pain interference items of the BPI serve as a reliable and valid measure of pain's impact on persons with CP-related pain.     

Behavioral Disturbances Among Medically Hospitalized School-Age Children

The purpose of this study was to examine the behavioral disturbances of medically hospitalized school-age children. Seventy-six school-age children, between the ages of 8 and 12, were the subjects. The children's usual prehospital behavior was reported by their mothers who completed the Child Behavior Checklist (CBCL). The hospitalized children were compared with the standardized nonclinical norms on the CBCL. Fifty-one percent of the children scored in the clinical range on one or both of the broad bands measuring behavioral disturbances: 21% on externalizing symptoms and 47% on internalizing symptoms. Total behavior problems and externalizing behavior were slightly associated with low socioeconomic status but not with the number of previous hospitalizations. Internalizing problems were not related to socioeconomic status nor the number of previous hospitalizations. The need for specialized mental health services to this population is discussed.     

Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study

The aims of this study were to: 1) estimate the prevalence of chronic pain (CP) and high impact chronic pain (HICP) in a community sample of children and adolescents; and 2) compare groups (those without CP, those with CP but no HICP, and those with HICP) with respect to demographic variables, pain variables, and physical, psychological, and school-related function. One thousand one hundred and fifteen children and adolescents participated (56% girls; age: ߂ = 11.67; SD = 2.47; range = 8–18 years). The prevalence of CP and HICP was 46% and 5%, respectively, and was higher in girls and increased with age. Participants with HICP reported greater pain intensity and higher pain frequency than those with CP but no HICP. In addition, participants with HICP reported lower mobility, greater fatigue, worst sleep quality, more anxiety and depression symptoms, worst cognitive function, missing more school days, and worse perceived school performance. HICP is a prevalent condition in children and adolescents and is associated with many negative consequences. Stakeholders must be aware of this and ensure that treatment programs are available to reduce the individual and societal impact of HICP in young individuals.PerspectiveThis article provides information on CP and HICP prevalence and impact in children and adolescents. By better understanding the nature and score of these conditions, we will be able to develop more effective early interventions to help this population and thereby reduce their long-term negative impact.     

Chirurgische Patienten mit chronischem Schmerz oder chronisch-postoperativem Schmerz

Introduction

The interference of biological, social, and psychological factors of the patient, collectively known as the biopsychosocial perspective, plays an important role in the chronification of postsurgical pain. The aim of this pilot study was to detect whether patients suffering from chronic pain without a relationship to a recent operation (CP) differ from chronic pain patients whose pain exists since a recent operation and is related with it (CPSP) in these factors.

Materials and methods

A step-by-step analysis of patients with chronic pain was conducted via a questionnaire of 36 questions in which mental state, pain, fear, and depression [Hospital Anxiety and Depression Scale – Deutsche Version (HADS-D), Chronic Pain Grade Questionnaire (CPGQ, von Korff), SF-12, McGill Pain Questionnaire (sensoric/affective)] were surveyed. Statistical analysis: Fisher’s exact test for counts, U test for continuous variables; group comparisons with: χ² test; p ?<?0.05 was considered significant.

Results

On average 29 months postoperatively (24–35?±?3.5 months), 113 chronic pain patients were analyzed. A group comparison between the CPSP group (n?=?73 with chronic postsurgical pain) and the group CP (n?=?29 with chronic pain) was conducted. Both groups showed highly significant reductions of SF-12 data compared to a German normal collective (p?<?0.001), but normal results regarding depression in the HADS-D and a moderately limiting, highly pain-related limitation in the CPGQ (von Korff III). No differences in the sensoric and affective parameters of the McGill Pain Questionnaire were found. Compared with the CPSP group, the CP group demonstrated higher pain intensities (p?=?0.022).

Conclusion

Regarding these results critically, there were no group differences concerning psychological and social patient factors in chronic pain patients with or without postsurgical pain.