Cognitive behavioral and behavioral interventions help young children cope during a voiding cystourethrogram

OBJECTIVE: To reduce young children's distress and increase coping behavior among children undergoing a voiding cystourethrogram (VCU). METHODS: Three- to seven-year-old children were stratified based on prior VCU experience and randomly assigned to an intervention (n = 20) or a standard care (n = 20) condition. The intervention included provision of information, coping skills training, and parent coaching. We hypothesized that the intervention would reduce children's distress as assessed by child report, parent and technician ratings, and behavioral observations. RESULTS: Children in the intervention displayed fewer distress behaviors and greater coping behaviors and were rated as more cooperative than children receiving standard care. Children's fear and pain ratings did not differ significantly between groups. CONCLUSIONS: A cognitive-behavioral treatment package effectively reduced children's distress, increased coping, and increased cooperation during voiding cystourethrogram procedures. This type of an intervention should be integrated into routine pediatric radiological procedures.     

Brief report: Optimizing children's memory and management of an invasive medical procedure: the influence of procedural narration and distraction

OBJECTIVE: To evaluate the influence of two interventions on children's memory of and distress during a voiding cysto-urethrogram (VCUG, X-ray of the kidneys). METHODS: Sixty-two children (aged 2.5-7.5 years) were allocated to one of three conditions. In one (CI + D), they received complete procedural information during the VCUG, with a cartoon video. In a second (PI + D), children received limited procedural information, with a cartoon video. In a third (standard care, PI), they received limited procedural information. VCUGs were videotaped and distress was coded using the CAMPIS-R. To assess memory, children were interviewed 1 week later. RESULTS: Relative to the PI condition, children in the CI + D condition recalled more information, appraised the VCUG as less painful, and were less distressed. There were no differences between the PI + D and PI conditions. CONCLUSIONS: An inexpensive, theoretically driven intervention can enhance children's memory and reduce distress during an invasive procedure.     

Sickle cell disease in children and adolescents: the relation of child and parent pain coping strategies to adjustment.

Examined pain coping strategies in 72 children and adolescents with sickle cell disease and their parents using the Coping Strategies Questionnaire, and found that pain coping strategies could be reliably assessed. Children high on Negative Thinking and Passive Adherence were less active, required more health care services, and were more psychologically distressed during painful episodes. Children high on Coping Attempts were more active and required less frequent health care services. Parents high on Coping Attempts and low on Passive Adherence had children who were more active.     

When distraction fails: parental anxiety and children's responses to distraction during cancer procedures

OBJECTIVE: To examine parental anxiety in the context of successful and unsuccessful distraction treatment of preschool aged children undergoing chemotherapy procedures. METHODS: Twenty-nine children (M age = 42 months) experiencing intramuscular or portacatheter injections participated in the study. Parents and children were shown how to use a portable electronic toy as a distractor during chemotherapy injections. Parental anxiety was assessed at baseline and child distress was coded during each procedure. RESULTS: Parents' baseline state anxiety accounted for 17% of the variance in changes in children's distress following distraction intervention. Parents of children who did not benefit from distraction reported significantly higher state anxiety at baseline than parents of the other participants. CONCLUSIONS: Results highlight the importance of examining individual outcomes in intervention studies and suggest that parents' emotional states may moderate distraction treatment outcome in young children. Future research formally testing parent anxiety as a moderator is recommended.     

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

OBJECTIVE: To evaluate the reliability and validity of a new observational measure of children's procedure-related distress behaviors, the Brief Behavioral Distress Scale (BBDS), to provide clinicians with an efficient, economical alternative measure that does not depend on continuous interval coding. METHODS: Forty-eight randomly selected videotaped invasive medical procedures performed on children (ages 2 to 10 years) with chronic illness were coded with the BBDS and the Observation Scale of Behavioral Distress (OSBD). Reliability and validity analyses along with item analysis were conducted. RESULTS: Total distress scores of the BBDS were highly correlated with six of seven concurrent validity measures from multiple sources (i.e., OSBD, parent ratings, two nurse ratings, child self-report, and a physiological arousal measure, heart rate) (range r =.57-.76, p <.001-.0001). A robust association was found between the BBDS distress scores and OSBD total distress scores (r =.72, p <.0001). For two concurrent validity measures, the BBDS demonstrated stronger associations than did the OSBD. Interrater reliability was high for each BBDS distress behavior category. CONCLUSIONS: Based on the findings reported, the BBDS is a reliable and valid measure of children's procedure-related distress with functional utility in both research and clinical settings.     

A primary preventive approach to children's drug refusal behavior: the impact of rehearsal-plus

The effectiveness of a short-term prevention program to increase drug refusal behavior in a school-age population was assessed. Forty-two third-grade children were randomly assigned to one of three groups: rehearsal-plus, traditional, or attention control. Children in the rehearsal-plus group were taught specific drug refusal techniques and appropriate social skills, and were provided a rationale for each response. This procedure included behavioral training and elaborative rehearsal. Training occurred in four socially validated situations corresponding to settings where children were likely to be offered drugs. The traditional procedure consisted of instructions derived from a "Just Say No" drug program. Assessment focused on specific refusal behaviors, procedural knowledge, and self-efficacy. Significant gains in desired functioning and appropriate behavioral and social skills were found. The effectiveness of the rehearsal-plus procedure as a method of increasing adaptive responding in dangerous and/or anxiety-arousing situations is discussed.     

Mothers' responses to children's negative emotions and child emotion regulation: the moderating role of vagal suppression

The current study examined the moderating effect of children's cardiac vagal suppression on the association between maternal socialization of negative emotions (supportive and nonsupportive responses) and children's emotion regulation behaviors. One hundred and ninety-seven 4-year-olds and their mothers participated. Mothers reported on their reactions to children's negative emotions and children's regulatory behaviors. Observed distraction, an adaptive self-regulatory strategy, and vagal suppression were assessed during a laboratory task designed to elicit frustration. Results indicated that children's vagal suppression moderated the association between mothers' nonsupportive emotion socialization and children's emotion regulation behaviors such that nonsupportive reactions to negative emotions predicted lower observed distraction and lower reported emotion regulation behaviors when children displayed lower levels of vagal suppression. No interaction was found between supportive maternal emotion socialization and vagal suppression for children's emotion regulation behaviors. Results suggest physiological regulation may serve as a buffer against nonsupportive emotion socialization.     

Testing the theoretical framework of the COPE program for mothers of critically ill children: an integrative model of young children's post-hospital adjustment behaviors

OBJECTIVE: To test a theoretical model examining processes through which a parent-focused educational-behavioral intervention [Creating Opportunities for Parent Empowerment (COPE)] relates to children's post-hospital adjustment problems. METHODS: Mothers (n = 143) and their 2-7-year-old children, unexpectedly hospitalized in two pediatric intensive care units, were randomized to COPE or control conditions. Maternal measures included parental beliefs, anxiety, negative mood, and child adjustment 3 months post discharge. Observers rated maternal support of their children during hospitalization. RESULTS: Structural equation modeling suggested that the model tested provided a reasonable fit to the data [chi2 (97 df) = 129.43; p = .016; root mean square error of approximation = .048; comparative fit index = .95]. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge. CONCLUSION: Implementing COPE may help avert future mental health problems in this high risk population. Understanding the processes by which an already empirically validated program relates to child outcomes is likely to aid clinicians and administrators in the widespread uptake of the COPE program.     

Hugging my uncle: the impact of a parent training on children's comfort interacting with persons living with HIV

OBJECTIVE: HIV-related stigma affects not only persons living with HIV (PLwHIV) but also their communities and families including children. This study aimed to determine whether an interactive training administered to community parents significantly increases their children's reported comfort interacting with PLwHIV. METHODS: A randomized clinical trial with random-quota dwelling unit sampling and a random invitation to treatment had 238 parent and 238 child participants. RESULTS: For children of trained parents, significant increases in comfort were obtained, baseline to 6-month follow-up, on 14 of 22 reported daily activities with PLwHIV. For children who recently interacted with a person living with HIV, this comfort predicted the number of recent activities, even after controlling for closeness to the person living with HIV and for the number of persons with HIV known, living or deceased. CONCLUSIONS: Training parents to be HIV health educators of their children significantly impacts youth and shows promise for reducing HIV-related stigma and social isolation.     

Nurse Coaching and Cartoon Distraction: An Efective and Practical Intervention to Reduce Child, Parent, and Nurse Distress During Immunizations

Evaluated a low cost and practical intervention deigned to decreasechildren's, parents', and nurses'distress during children'simmunizations. The intervention consisted of children viewinga popular cartoon movie andbeing coached by nurses and parentsto attend to the movie. Ninety-two children, 4–6 yearsof age, and their parentswere alternatively assigned to eithera nurse coach intervention, a nurse coach plus train parentand child intervention, or a standard medical care condition.Based on previous findings of generalization of adult behaviorsduring medical procedures, it was hypothesized that trainingonly the nurses to coach the children would cost-effectivelyreduce all participants levels of distress. Observational measuresand subjective ratings were used to assess the following dependentvariables: children's coping, distress, pain, and need for restraint;nurses' and parents' coaching behavior; and parents' and nurses'distress. Results indicate that, in the two intervention conditions,children coped more and were less distressed, nurses and parentsexhibited more coping promoting behavior and less distress promotingbehavior, and parents and nurses were less distressed than inthe control condition. Although neither intervention was superioron any of the variables assessed in the study, nurse coach wasmarkedly more paractical and cost-effective .therefore, nurses'coaching of children to watch cartoon movies has great potentialfor dissemination in pediatric settings     

Effects of Parent Presence on Children's Reactions to Injections: Behavioral, Physiological, and Subjective Aspects

Observed 47 children ranging in age from 13 months to 7 years9 months receiving injections as part of a regular visit toa pediatric clinic. Twenty-three children were randomly assignedto a condition with parent (mainly mothers) present and 24 toa condition with parent absent. During the medical procedure,the child's reactions were observed via videotape (for laterbehavioral coding) and physiological recording (to measure heartrates). Following the injection, data were collected on thechild's preference of condition (either parent present or parentabsent) for future injections. Older children (but not youngerones) showed significantly more behavioral distress when theparent was present. However, the oldest children's preferenceof condition for future injections was overwhelmingly that ofparent present (86%).     

Parents of Children with Cancer: A Longitudinal Study of Emotional Distress, Coping Style, and Marital Adjustment Two and Twenty Months After Diagnosis

Evaluated emotional distress, coping style, and marital adjustmentin 84 parents (42 couples) of children with cancer 2 monthsafter diagnosis and again about 20 months after diagnosis. Asexpected, mothers' mean state anxiety and trait anxiety scoresdecreased to near normal levels over time. Fathers' scores werelower initially and did not change. Neither mothers' nor fathers'mean marital adjustment scores changed over time. Marital adjustmentat treatment follow-up was predicted by depression and the spouse'smarital satisfaction in mothers, and depression, child healthstatus, and spouse's marital satisfaction in fathers. In contrastto findings obtained 2 months after diagnosis, coping stylewas not related to marital adjustment at follow-up. Resultsare discussed in terms of possible gender differences in therole of social support in marital adjustment and the stabilityversus situational specificity of coping styles.     

Society of Pediatric Psychology Student Research Award: Parent and Staff Behavior, Previous Child Medical Experience, and Maternal Anxiety as They Relate to Child Procedural Distress and Coping

Assessed the influence of adult in-session behavior and psychologicalvariables on 77 preschool children's coping and distress duringroutine immunizations. Maternal anxiety was not related to thebehavior of the parent, staff, or child. However, in-sessionbehavior by one person was highly correlated with insessionbehavior by the other people in the treatment room. The effectsof parent and staff in-session behaviors, previous child medicalexperience, and maternal anxiety on child distress and copingwas examined using hierarchical multiple regression procedures.Child coping was predicted by parent and staff behavior whereaschild distress was predicted by parent behavior and by the levelof the child's distress during previous medical and dental experiences.Implications for intervention and future research are discussed.     

Learning to cope with everyday instances of social exclusion: A review of emotional and cognitive strategies for children and adolescents

Over 20 years of research has shown that social exclusion is a pervasive and powerful form of social threat. Social exclusion causes a wide variety of negative outcomes including negative emotions and threats to fundamental human needs (i.e., self-esteem). Most importantly, experiencing exclusion during childhood or adolescence can provoke long-term negative effects such as depression and anxiety disorders. Despite the growing interest in this domain, only recent studies have started to examine possible coping strategies to contrast the negative effects of exclusion. In this article, we first review the empirical findings concerning the consequences of social exclusion in children and adolescent populations. Second, we focus on cognitive and socio-emotional strategies that children and adolescents can use to deal with exclusion when it has occurred. Implications and future directions are discussed.     

Infant emotion regulation and cortisol response during the first 2 years of life: Association with maternal parenting profiles

This study investigated the prospective associations among emotion expression, behavioral regulation, and cortisol responses in relation to different maternal parenting behaviors during the first 2 years of the infant's life, among a sample of low-income families. Participants included 1,141 mother–child pairs, assessed when the infants were 6, 15, and 24 months old. Maternal parenting behaviors were observed at the 6-month assessment, whereas infant emotion expression, orienting toward mothers, and cortisol responses were measured using a series of emotion-eliciting tasks at all time points. A latent profile analysis revealed four maternal parenting profiles: Detached, Intrusive, Average, and Engaged. Furthermore, a multiple-group path model revealed distinct patterns of emotion development for infants within different maternal parenting groups. Among children with Engaged and Average mothers, orienting behaviors tended to predict less negative emotion and cortisol responses, which was associated with more future orienting behaviors. Conversely, among children with Intrusive and Detached mothers, orienting behaviors tended to predict more negative emotion and cortisol responses, which predicted less future orienting behaviors. Findings of this study enhance current understanding of how different profiles of maternal parenting behaviors impact infant emotional development in poverty, with significant implications for intervention programs targeting early mother–infant interactions.     

Divergent effects of active coping on psychological distress in the context of the job demands-control-support model: the roles of job control and social support

This study examined the effects of active coping on psychological distress in the context of the job demands-control-support model. Participants were 726 male nonmanagers in a large electrical company in Japan. Hierarchical multiple regression analyses were conducted to examine whether active coping and coping resources (job control, supervisor support, and coworker support) have interaction effects on psychological distress. Active coping had an interaction effect with coworker support, whereas it did not with job control and supervisor support. Results suggest that coworker support can facilitate the effectiveness of active coping, whereas job control or supervisor support cannot.     

Psychological adjustment of children with cystic fibrosis: the role of child cognitive processes and maternal adjustment.

Found 60% of children 7-12 years old with cystic fibrosis to have a parent-reported behavior problem and 62% met the criteria for a DSM-III diagnosis based on a structured clinical interview with the child. Mixed internal and external behavior problem patterns and diagnoses of anxiety and oppositional disorder were most frequent. Support was provided for the hypothesized psycho-social/mediational roles of child perception of self-worth and maternal anxiety in child adjustment. Together, the variables of the transactional stress and coping model accounted for 39 and 43% of the variance in mother-reported internalizing and externalizing behavior problems and for 68% of the variance in child-reported problems.     

Disentangling the effects of current age, onset age, and disease duration: parent and child attitudes toward diabetes as an exemplar.

OBJECTIVE: To develop a methodology for use with cross-sectional data to disentangle the effects of current age, disease onset age, and disease duration in chronically ill children. METHODS: We used a questionnaire data set from a large cross-sectional sample of mothers and children with Type 1 diabetes. The interdependence of current age, onset age, and disease duration precluded use of all three in the same regression model. Consequently, pairs of models were run, looking for a pattern in the results. RESULTS: The approach successfully disentangled the differential effects of the child's current age, disease onset age, and disease duration. Child current age predicted child attitudes about diabetes management rules, child sick-role identification, and maternal attitudes toward medical staff. Onset age predicted child-perceived family disruption and mothers' confidence in detecting a hypoglycemic reaction. Disease duration predicted maternal religious beliefs about diabetes and maternal attitudes toward medical staff. CONCLUSIONS: This study illustrates a methodology for disentangling the effects of child current age, disease onset age, and disease duration in cross-sectional data that may be useful for any childhood chronically ill population that varies in child onset age.     

Relationships between family and parent characteristics and functional abilities in children with recurrent pain syndromes: an investigation of moderating effects on the pathway from pain to disability

OBJECTIVE: To identify family characteristics associated with children's ability to function with recurrent pain. METHODS: Seventy-eight children ages 7-17 years with recurrent pain syndromes [migraine headache or recurrent abdominal pain (RAP)] were recruited from clinic settings. Children completed pain diaries and the Functional Disability Inventory (FDI). Mothers and fathers completed self-report measures of psychological distress, and mothers reported on family environment. RESULTS: Controlling for the influence of pain intensity, family environment and parental distress jointly predicted children's ability to function with pain. Among children with migraine, family environment moderated the relationship between pain and functional disability; in this group, greater pain associated with more functional disability in children from disruptive family environments, but not in children from more adaptive family environments. CONCLUSIONS: For some pediatric recurrent pain sufferers, family characteristics associate with the extent of pain-related disability and may help identify children likely to experience more impaired functioning in response to recurrent pain.