Assessing health-related quality of life in children with recurrent headache: reliability and validity of the PedsQLTM 4.0 in a pediatric headache sample

OBJECTIVE: To evaluate the reliability and validity of a commonly used measure of health-related quality of life (HRQOL), the Pediatric Quality of Life Inventory (PedsQL 4.0), in a sample of children with a recurrent headache syndrome. METHODS: Participants were 40 children aged 7-12 who completed measures of HRQOL, headache-related disability, and headache activity during a baseline period and following a self-directed cognitive-behavioral intervention. RESULTS: The data are supportive of the reliability (internal consistency and test-retest) and validity (criterion related, convergent, known-groups, and responsiveness to intervention) of the PedsQL 4.0 within a pediatric headache sample. CONCLUSIONS: We conclude that the PedsQL 4.0 is a reliable and valid measure of HRQOL in children with recurrent headache and captures important information not routinely evaluated in chronic pain populations.     

A parent form of the Children's Depression Inventory: reliability and validity in nonclinical populations

A parent form of the Children's Depression Inventory (CDI) was investigated in a nonclinical population. In Study 1, the CDI was administered to 50 children and their mothers. One month later, the CDI was readministered to 45 children and their mothers. Children's and mother's CDI ratings were correlated significantly at both Time 1 (r = .37) and Time 2 (r = .59). Test-retest reliability of the Parent-CDI over the 1-month interval was significant (r = .75). In study 2, 96 children were rated by mothers on the CDI. Eighty-one of these children rated themselves on the CDI, and 72 were rated by teachers on the Children's Depression Rating Scale (CDRS). The Parent-CDI was found to be correlated significantly with both the CDI (r = .66) and the CDRS (r = .64). Internal consistency of the Parent-CDI was demonstrated by both a split-half and an item-total analysis. Merits and limitations of this parent form of the CDI for use within a nonclinical population are discussed.     

The children's eating behavior inventory: reliability and validity results.

Eating and mealtime problems are common in childhood. They occur across a broad age span, in normally developing children and in a wide variety of developmental and medical disorders. There is no currently available standard instrument by which to assess these problems. The Children's Eating Behavior Inventory (CEBI) was developed according to a conceptual framework based upon a transactional/systemic understanding of parent-child relationships. It was completed by 206 mothers of nonclinic children and 110 mothers of clinic children. Results of test-retest and internal reliability testing indicate that the CEBI meets criteria for instrument reliability. Construct validity is demonstrated by the significant difference between the clinic and nonclinic groups in the mean total eating problem score and in the mean number of items perceived to be a problem.     

Investigating validity and reliability evidence for the maternal antenatal attachment scale in a sample of Italian women

This study focused on the development of the emotional tie of the expectant mother towards her unborn child and aimed to achieve structural and external validity evidence for an Italian version of the Maternal Antenatal Attachment Scale (MAAS; Br J Med Psychol 66: 167–183, 1993). The MAAS was translated into Italian and was administered to a sample of 482 Italian expectant women (age 20–43 years), together with other questionnaires measuring maternal–fetal attachment, psychological well-being, and relational variables. The hypothesised relationships with external concurrent and predictive criteria were substantiated. Internal consistencies were adequate for the total scale and for one of the two subscales. Confirmatory factor analyses provided general support for an oblique two-factor model, with minor model misfit. Therefore, an exploratory factor analysis with oblimin rotation was performed. The findings suggested that some items may represent extraneous constructs. Implications for future research regarding the functioning of the instrument are addressed.     

Spanish Version of the Children's Somatization Inventory: Factorial Structure and Psychometric Properties in a Community Sample

Background

The Children's Somatization Inventory (CSI) has proved to be a suitable measure to assess somatic symptoms in pediatric patients, but additional research was needed to evaluate its psychometric properties in community populations.

Purpose

The objective of the present study was to examine psychometric properties and factorial structure of the instrument among a nonclinical sample of Spanish children.

Method

The 24-item version of the CSI and two self-report measures of anxiety and depression were administered to 1,111 Spanish children aged 8 to 12.

Results

Exploratory analysis suggested a factorial structure composed of three factors: pseudoneurologic symptoms, gastrointestinal symptoms, and pain. Due to confirmatory analysis indicating a poor fit for the three-factor model, two alternative models were tested. A six-item single factor identified in a previous study with an American community sample showed the best fit (RMSEA?=?0.04; GFI?=?0.99; AGFI?=?0.98; CFI?=?0.98; χ²/gl?=?2.71). The internal consistency for the six-item version was acceptable (ω?=?.71), and the construct validity with anxiety (r?=?.53) and depression (r?=?.38) measures was adequate.

Conclusion

The six-item version of the CSI demonstrated to be a reliable measure for assessing somatization symptoms in Spanish children.     

Reliability and validity of the Asthma Trigger Inventory applied to a pediatric population

OBJECTIVE: To test the reliability and validity of the Asthma Trigger Inventory (ATI) applied to a pediatric population. METHOD: Children with asthma (N = 272, 56% male, age 7-17) and their primary caregivers answered together an asthma trigger inventory, ATI (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006) developed for adults. Cronbach's alpha, principal component analysis (PCA), hierarchical regression, and correlations of the ATI subscales with skin prick tests, psychological questionnaires, and disease severity were used to assess the psychometric properties of the ATI. RESULTS: The ATI subscales demonstrated excellent reliability regardless of gender, race, socioeconomic status (SES), or age. PCA confirmed and replicated the theoretical structure of the ATI. Hierarchical multiple regressions illuminated the association of ATI subscales with demographics and asthma history. Evidence in support of construct validity was found in associations between ratings of triggering and disease severity and asthma-related quality of life (PAQLQ). Criterion validity for allergy triggering was partially supported by correlations between ATI animal allergens subscale and the cat dander skin prick test, and construct validity for emotional triggering by associations between the emotional trigger subscale score and the anxiety (STAIC) and depression (CDI, CDI-P, CDRS-R, and CBCL-I) scores. CONCLUSION: The ATI holds promise as a reliable, valid, and useful clinical and research tool to assess the type and degree of asthma triggering in a pediatric population (age 7-17) of varied gender, race, and SES.     

Living with a chronic illness: a measure of social functioning for children and adolescents

OBJECTIVE: To describe the development and initial psychometric evaluation of a measure of social functioning in children and adolescents with chronic medical conditions, Living with a Chronic Illness (LCI), designed to distinguish social difficulties related to the illness from those social difficulties associated with other factors (e.g., limited income). METHODS: Parents (n = 108) and youths (n = 115) completed the LCI, along with other psychological measures (e.g., Youth Self-Report). Teachers completed the Teacher Report Form and provided grade and absence data. Health care utilization data were obtained from medical charts. RESULTS: Statistical analyses supported the internal consistency and initial validity of LCI scores. Correlational results strongly point to the distinction made between illness-related and non-illness-related social difficulties and suggest that the LCI has some relation to existing measures (e.g., Child Behavior Checklist), while still providing a unique perspective on children's social functioning. Univariate and regression analyses revealed significant relations between LCI scores and health care utilization. CONCLUSIONS: These findings support the initial psychometric properties and clinical utility of the LCI scores. We discuss strengths and limitations of this study, as well as potential clinical applications for the LCI questionnaire.     

Cetirizine treatment of rhinitis in children with pollen allergy: evidence of its antiallergic activity

Background Cetirizine is an antihistamine, largely used in the treatment of allergic rhinoconjunctivitis, which also exerts anti-allergic activity. Objectives To evaluate cetirizine as treatment for children with rhinitis due to pollen allergy, and to evaluate its anti-allergic activity in such a clinical condition. Methods The study was designed as parallel groups, double-blind, placebo-controlled, randomized. Twenty allergic children were enroled and subdivided in two groups, receiving a 4 week treatment during the pollen season. The following parameters were monitored: clinical symptoms evaluated by the allergist before and after treatment and by the patients through a daily diary card, inflammatory cells count, expression of ICAM-1 on nasal epithelial cells, inflammatory mediator levels in nasal Iavage and peripheral blood before and after treatment, and pollen counts. Results This study shows that cetirizine treatment is able to reduce: clinical symptoms (P < 0.01), inflammatory cell infiltrate (P < 0.03), ICAM-1 expression on epithelial cells (P < 0.05), and soluble ICAM-1 (P < 0.05) and ECP (P < 0.05) in nasal lavage. Conclusion Cetirizine is able to clinically improve nasal symptoms due to pollen allergy and to reduce allergic inflammation, which is related to allergen exposure.     

Physical health correlates of Type A behavior in children and adolescents

A physical examination including resting blood pressure, heart rate, Tanner scales, height, and weight was administered to 184 students in the fifth, seventh, and ninth grades. They completed the Physical Symptoms of Stress Inventory, Health Habits Inventory, and two self-monitoring logs of physical symptoms. School absenteeism, medical records, physician ratings, and family health history data were collected. No significant differences between high-and low-Type A behavior pattern (TABP) subjects were found on any of the physical measurements. However, retrospective and prospective reports of physical symptoms revealed a consistent pattern: high TABP subjects reported significantly more physical symptoms than low-TABP subjects. Self-ratings of stress and tension were significantly higher for high-TABP subjects. High-TABP subjects, however, neither missed more school because of illness nor used physician services more often than low subjects. Further, expected relationships between physical symptoms and illness behavior, including school absence, were evident only for low subjects.Support for this research was provided by a grant from the John D. and Catherine T. MacArthur Foundation. We gratefully acknowledge the assistance of our project secretary, Donna Juds Gomola.     

Health-related quality-of-life measures for children with asthma: reliability and validity of the Children's Health Survey for Asthma and the Pediatric Quality of Life Inventory 3.0 Asthma Module.

BACKGROUND: Economically disadvantaged African American youth are especially vulnerable to the effects of pediatric asthma and are at increased risk for difficulties in daily functioning. Measures of health-related quality of life (HRQoL) yield important information regarding the impact of pediatric chronic illness on daily functioning. It is essential to develop and validate measures of HRQoL to detect the impact of asthma on this vulnerable population. OBJECTIVE: To examine the psychometric properties of 2 asthma-specific measures of pediatric HRQoL in a sample of economically disadvantaged African American children diagnosed as having asthma. METHODS: One hundred twenty-seven caregivers completed questionnaires regarding their child's HRQoL, asthma symptoms, health care utilization, and school absences and regarding caregiver emotional distress. The severity of the child's asthma was measured via spirometry. RESULTS: The Children's Health Survey for Asthma and the Pediatric Quality of Life Inventory 3.0 Asthma Module demonstrated adequate internal consistency reliability and validity for the present sample. Lower HRQoL was associated with poorer adherence and more health care utilization, asthma symptom days, school absences, and caregiver distress. Only the Children's Health Survey for Asthma was significantly associated with severity, when defined as airway obstruction. CONCLUSIONS: This study supports the psychometric equivalence of 2 condition-specific measures of HRQoL in a population at high risk for asthma and asthma-related problems. The utility of each measure will depend on the needs of the researcher or physician. Both measures can inform the treatment course, help identify and address barriers to treatment adherence, and inform treatment interventions.     

Current measures of PTSD for children and adolescents

OBJECTIVE: To review measures of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PSS) for children and adolescents. METHODS: We reviewed broad-based child mental health journals within the disciplines of pediatrics, child psychology, and trauma, from 1995 to 2004, to identify measures of PTSD and PSS for children and adolescents. The review includes a summary of the psychometric properties and associated features of the measures and the clinical domains and types of studies using each measure. RESULTS: Seven measures of PTSD and PSS were identified, including clinician-administered interviews and self-report questionnaires. Sixty-five articles containing the measures were categorized into eight trauma domains. We found there is little consensus over measures used within each trauma domain. CONCLUSIONS: Few measures of PTSD and PSS have been designed specifically for young people. Further directions for measurement of PTSD in this age group are discussed to prevent under-diagnosis and under-treatment for youth.     

Pain in children and adolescents with sickle cell disease: a descriptive study

In sickle cell disease, vaso-occlusion in the small blood vessels leads to bone or joint pain which is variable in intensity and duration. An essential first step toward the development of specific treatment guidelines for such painful episodes in children and adolescents is the accurate evaluation of pain. The systematic assessment of vaso-occlusive pain is addressed through two separate studies. In the first, 35 pediatric sickle cell disease patients between 5 and 16 years of age were evaluated in an outpatient clinic with the Varni/Thompson Pediatric Pain Questionnaire. In the second, data were gathered over the course of hospitalizations for uncomplicated vaso-occlusive episodes in 17 adolescent patients. Results showed that this pain experience can be quantified, that vaso-occlusive pain spans a broad range of intensity levels, and that there are a number of socioemotional factors associated with the pain experience. Further research to systematically assess the psychometric properties of pain assessment instrument is recommended.     

The management of mature cystic teratomas in children and adolescents: a retrospective analysis

Mature cystic teratomas (MCT) are the most common ovarian tumours seen in children and adolescents. Fifty-two patients <21 years of age had surgical removal of an MCT, 14 of whom were approached laparoscopically. Compared with laparotomy, those patients managed laparoscopically had a significantly shorter hospital stay. Intra-operative tumour spillage occurred in 27 (52%) patients; there were no cases of chemical peritonitis. Available follow-up data on 34 (65%) patients revealed seven pregnancies occurring at a median of 70 months (46-123) postoperatively, including four in patients with intraoperative MCT spill. There were no cases of tumour recurrence during the follow-up period among the 27 (52%) patients managed with ovarian cystectomy. These results demonstrate that some of the conclusions regarding the contemporary management of MCT in adults are applicable to children and adolescents.     

Prefrontal substrates of empathy: psychometric evidence in a community sample

Empathy is a vicarious experience of others’ emotions, and is crucial to many forms of adaptive social interaction. Clinical, experimental, and functional neuroimaging studies convergently suggest a role for prefrontal-limbic circuits in mediating empathy. This study examined the prefrontal basis of empathy in a community sample using self-report measures: the frontal systems behavior scale (FrSBe), Barratt impulsiveness scale (BIS), and the interpersonal reactivity index (IRI). Multiple correlations emerged supporting an inverse relationship between prefrontal system dysfunction and empathy, particularly emotional empathy and perspective taking. Many of these relationships persisted after controlling for age, sex, and education. However, FrSBe scales did not correlate with one's identification with fictional characters, and motor impulsivity correlated positively, presumably due to the different cognitive and emotional context (i.e. real versus fictional individuals). These studies parallel others using objective methodologies and suggest a graded relationship between prefrontal function and empathy and likely reflect normal variations in prefrontal-limbic function.     

Brief report: Development and pilot testing of a coping questionnaire for children and adolescents with chronic health conditions

OBJECTIVE: The current paper describes the development, pilot testing, and item reduction process of a coping questionnaire for children and adolescents with chronic health conditions. METHODS: A pilot test with 188 children and adolescents was conducted in six European countries. Included in the test were children and adolescents (ages ranging 8-18 years) with various chronic health conditions-asthma, epilepsy, diabetes, arthritis, atopic dermatitis, cerebral palsy, or cystic fibrosis. Based on the focus groups with the children and adolescents and on expert consulting, items were developed and translated into the participants' respective languages. Data were analyzed according to predefined psychometric and content criteria. RESULTS: Analyses resulted in a selection of 29 out of 50 items for the final coping questionnaire with six domains: Acceptance alpha = .83, Avoidance alpha = .72, Cognitive-Palliative alpha = .69, Distance alpha = .70, Emotional Reaction alpha = .82, and Wishful Thinking alpha = .81. CONCLUSIONS: This study developed a short reliable international questionnaire to assess coping strategies of children and adolescents with chronic health conditions. Ongoing research will investigate the validity of this new coping questionnaire.     

Fear of hypoglycemia in children and adolescents with diabetes

Extended a study of diabetic adults which showed that fear of hypoglycemia is common and may affect diabetic control. That study evaluated the psychometric properties of the Hypoglycemic Fear Survey (HFS), an instrument designed to measure fear of hypoglycemia. The present study evaluated the psychometric properties of the HFS with diabetic youth. The HFS was completed by 128 Ss on arrival at a diabetes summer camp, by 127 Ss at the end of the 7-day camp, and by 74 Ss 12 weeks after camp. The results support the internal consistency and test-retest reliability of the HFS with this age group. Factor analytic and multiple regression techniques support the construct validity of the scale. HFS scores enhanced prediction of diabetic control. The HFS appears to be useful as a research tool with children and adolescents, although cross-validation is needed before clinical use can be justified.     

Children's perceptions of peers with somatic symptoms: the impact of gender, stress, and illness

OBJECTIVE: To investigate how illness characteristics influence children's responses to ill peers. METHODS: A sample of 363 4th and 5th graders responded to a vignette describing a peer with abdominal pain. In a 2 x 2 x 2 x 2 design, conditions varied by (a) evidence for organic disease, (b) presence of stress, (c) sex of vignette character, and (d) sex of respondent. Children rated symptom severity, liking for the peer, and whether the peer should be excused from normal responsibilities. RESULTS: Same sex preferences significantly influenced children's liking for a peer. Children viewed symptoms with an organic etiology as more severe than those without one. Under certain conditions, symptom severity judgments mediated the relation between the presence of organic disease and (a) liking and (b) granting relief from responsibility. The presence of stress had little effect on ratings of symptom severity, liking, or relief from responsibility. CONCLUSIONS: Gender and evidence of organic disease influence children's perceptions of and responses to symptomatic peers.     

Preliminary report on reliability and validity of the trait form of the Depression Adjective Check List in a representative community sample

The purpose of this study was to investigate preliminary internal consistency and split-half reliability estimates of the trait form of the Depression Adjective Check List-Form E (DACL-E), as well as to validate three specific adjectives. The sample consisted of 294 residents of 17 inner-city neighborhoods of a large midwestern city, selected through a modified cluster sampling procedure. The Cronbach's alpha and split-half reliability estimates were similar in magnitude for both genders (.88 for males and .85 for females) and were at a level generally found to be reliable. Analyses of the three DACL-E adjectives--"distressed," "safe," and "active"--were related, respectively, to fear of crime (p less than .01), perception of one's safety (p less than .01), and active participation in crime prevention activities (p less than .001).     

The Personality Inventory for Children (PIC): An Unbiased Predictor of Cognitive and Academic Status

Although different demographic groups of children often obtainunequal mean scores on IQ tests, test bias is only present whenexternal criteria are differentially predicted across thesegroups. Concern about possible racial bias is relevant for severalrecently developed parent- or teacher-informant behavior ratinginventories that incorporate scales designed to predict thecognitive status of children. Using a multiple regression procedure,the scales of the Personality Inventory for Children (PIC) wereevaluated to determine whether they were biased according torace, sex, or age in their relationship to several cognitiveand academic tests. The three PIC profile scales which measurechild cognitive status (cognitive triad) obtained substantialcorrelations with these tests which were free of these biaseffects within a sample of 329 children and adolescents evaluatedby a child guidance facility. As expected, PIC scales reflectingchild affect or behavior did not generally correlate significantlywith these cognitive measures.