Body image and children's mental health related behaviors: results from the healthy passages study

OBJECTIVE: This study examined the relationship between body image discrepancy (BID) scores for actual versus ideal body image for children and indicators of child mental health. METHODS: Data were collected from 650 5th graders and their parents who participated in the Healthy Passages Phase I study. Participants were recruited through schools in Alabama, California, and Texas. Measures included the Collins Body Image to produce child- and parent-reported child BID scores, respectively, body mass index (BMI) for child and parent, the Strengths and Difficulties Questionnaire (SDQ), and the Positive and Negative Affect Scale for Children (PANAS-C). RESULTS: After controlling for potential confounders, children's internalizing problems as rated by parents and negative affect as rated by children were significantly associated with discrepancies based on child- and parent-reported child BID scores, respectively. CONCLUSIONS: Overall, higher child- and parent-reported child BID scores were significantly associated with more internalizing problems and negative affect among children. There were some inconsistencies in the associations between other mental health behaviors and child BID scores contingent on parent or child ratings. Early intervention may be indicated to prevent possible adverse consequences, especially for internalizing problems, from the effects of child- and parent-reported child BID scores on adolescent and adult mental health and well-being.     

A randomized controlled trial of a cognitive-behavioral family intervention for pediatric recurrent abdominal pain

OBJECTIVE: To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdominal pain (RAP) was more effective than SMC alone. METHODS: Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple dimensions of child and parent reported child pain, somatization, and functional disability, and school absences and physician contacts. RESULTS: Children and parents participating in the combined SMC + CBT intervention reported significantly less child and parent reported child abdominal pain than children in the SMC intervention immediately following the intervention and up to 1 year following study entry, as well as significantly fewer school absences. Significant differences in functional disability and somatization were not revealed. CONCLUSIONS: These results, in combination with previous studies, add support to the effectiveness of CBT intervention in reducing the sensory aspects of RAP. Results are discussed with respect to the cost-benefit of integrated medical and short-term psychological services.     

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.     

Does "telling" less protect more? Relationships among age, information disclosure, and what children with cancer see and feel

Parents report telling young children less about the diagnosis, treatment, and prognosis of cancer than older children and adolescents. This is often based on the desire to spare children from being overwhelmed. 43 children diagnosed with cancer reported on information disclosed to them at diagnosis, their causal attributions, illness-related stress, and coping strategies. Consistent with parental reports, children under 9 years (n = 18) were told less than children 9-14 years (n = 15) and adolescents (n = 10). Young children's reports of illness impact differed from older children and adolescents only with respect to school and social domains. Younger children reported fewer cognitive strategies than older children and adolescents. Even though young children were told much less than older children they reported similar levels of distress. This suggests that nondisclosure fails to mask the salient and distressing aspects of the illness.     

Quality of life in children surviving cancer: a personality and multi-informant perspective

OBJECTIVE: To describe quality of life (QoL) of children surviving cancer in relation to their personality, using self- and maternal reports and examining differences with healthy referents. METHOD: Sixty-seven children who survived childhood cancer were compared with eighty-one healthy children on QoL and personality characteristics. RESULTS: Children who survived cancer reported higher QoL than healthy children, whereas there were no differences for personality. Two main effects emerged for informant with children rating themselves as less neurotic and more conscientious than their mothers. The correspondence between mothers and children was substantially higher for survivors for QoL and personality ratings. QoL and trait measures share substantial variance, and personality traits significantly predict QoL. Parental personality ratings explained child QoL beyond children's personality ratings. CONCLUSIONS: Personality traits contribute to quality of life, indicating that personality significantly influences child's quality of life beyond the experience of a negative life event such as surviving cancer and its treatment. From a diagnostic perspective, parental trait ratings are informative in addition to children's ratings of personality to understand children's QoL.     

The relationship of parental overprotection, perceived child vulnerability, and parenting stress to uncertainty in youth with chronic illness

OBJECTIVE: To examine the relationship of parent-reported overprotection (OP), perceived child vulnerability (PCV), and parenting stress (PS) to youth-reported illness uncertainty, and to explore potential developmental differences. METHOD: Eighty-two children and 82 adolescents (n = 164) diagnosed with Type 1 diabetes mellitus (DM1) or asthma, completed a measure of illness uncertainty, while their parents completed measures of OP, PCV, and PS. RESULTS: After controlling for demographic and illness parameters, both PCV and PS significantly predicted youth illness uncertainty in the combined sample. Within the child group, only PS significantly predicted illness uncertainty, whereas only PCV significantly predicted uncertainty for adolescents. CONCLUSION: Specific parenting variables are associated with youth-reported illness uncertainty; however, their relationship varies according to developmental level. Although OP has been identified as a predictor of child psychological outcomes in other studies, it does not appear to be associated with illness uncertainty in youth with DM1 or asthma.     

Environmental Contributions to Social and Mental Health Outcomes Following Pediatric Stroke

Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children’s social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children’s outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.     

Childhood chronic illness as a family stressor.

Investigated the impact of childhood chronic illness within a family context. We interviewed 30 mothers of 6- to 14-year-old children with asthma or diabetes and 30 mothers of healthy children of the same age and sex. Family functioning, extrafamilial social support available to mothers, and child life stress events were examined in relation to the children's psychological adjustment and illness events. The mothers of asthmatic children reported a greater number of internalizing behavior problems in their children, perceived their own social support as less adequate, and reported a greater number of stressful events. Regression analyses demonstrated that family functioning, maternal social support, and chronic illness were significantly related to the psychological adjustment of the child. The importance of family functioning and resources available to the family, such as social support, are discussed as protective influences in coping with childhood chronic illness.     

A meta-analysis of the effects of psychological interventions in pediatric oncology on outcomes of psychological distress and adjustment

OBJECTIVE: To estimate the effectiveness of psychological interventions in pediatric oncology on decreasing psychological distress and increasing psychological adjustment using meta-analytic methods. METHODS: A meta-analysis was conducted on 12 psychological intervention studies in pediatric oncology using a weighted least squares (WLS) approach and random effect models. RESULTS: Effect sizes significantly different from zero were found for parent distress (mean = 0.35, 95% CI = 0.20-0.49, n = 7) and parent adjustment (mean = 0.23, 95% CI = 0.07-0.40, n = 5). Effect sizes for child distress, child adjustment, parent-reported child distress, and parent-reported child adjustment were not significantly different from zero. CONCLUSIONS: Psychological interventions in pediatric oncology show promise in decreasing distress and improving the adjustment of parents of children with cancer but may have minimal effects for child outcomes. Methodological issues of intervention research are discussed.     

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.     

A sequential analysis of parent-child interactions in anxious and nonanxious families

Although theoretical work has suggested that reciprocal behavior patterns between parent and child may be important in the development of childhood anxiety, most empirical work has failed to consider the bidirectional nature of interactions. The current study sought to address this limitation by utilizing a sequential approach to exploring parent-child interactions. Participants included 161 children (ages 3-12 years) and their parents. Parent and child dyads were classified into four categories: anxious parent-anxious child (n = 45), anxious parent-nonanxious child (n = 45), nonanxious parent-anxious child (n = 21), and nonanxious parent-nonanxious child (n = 50). Parent and child behaviors were coded from two 10-min interactions. Results indicated that anxious parents of children with anxiety disorders were more likely to respond with negative behaviors, which their child then mirrored. Nonanxious parents of nonanxious children responded with more warmth, which was then mirrored by their child. These results provide evidence for differential patterns of behaviors between anxious and nonanxious parents and children following critical moments in their interactions.     

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.     

The Role of Social Support in Parental Adjustment to Pediatric Cancer

During the course of their child's illness and medical treatment,parents of children with cancer may experience many difficultchallenges. Though there is evidence that social support canhelp mitigate problems associated with other major life stresses,little empirical research has been conducted on the effectsof social support on the psychosocial problems of the familywhen a member is being treated for cancer. The present studysystematically assessed adjustment difficulties in 107 parentsof children with cancer. Stage of treatment for cancer, parentage, and parent sex were examined for differing patterns ofpsychosocial adjustment. Younger parents (< 30 years of age)reported significantly greater psychosocial adjustment difficultiesthan older parents (> 30 years) in their domestic environment,sexual relations, extended family relationships, personal psychologicaldistress, as well as total psychosocial adjustment. Parentswhose child had died demonstrated significantly poorer adjustmentin their extended family relationship, domestic environment,as well as in their overall psychosocial adjustment. Severalperceived sources of social support appeared to mitigate psychosocialadjustment difficulties in parents whose child was currentlyin treatment. In parents whose child was alive but not undergoingactive medical treatment, only support from relatives appearedto temper adjustment difficulties. Parents whose child had dieddid not appear to benefit from any source of social support.The results are discussed in terms of the identification ofa potentially high-risk group for psychosocial difficulties.     

Parents have both implicit and explicit biases against children with obesity

Weight bias (negative attitudes towards individuals with obesity) has been widely observed, but not examined in parents. In this study, we measured parents’ (N?=?658; 74.2% female) explicit and implicit weight bias against children with obesity. Many parents (n?=?612; 93%) endorsed some moderate explicit weight bias. Fathers had greater explicit bias than mothers and parents with overweight/obesity had less bias than those with healthy-weight. Other parent/child variables (i.e., parent age, child sex, child weight, child age) were not significantly associated with explicit bias. Parents also demonstrated implicit weight bias. No parent or child variables were significantly associated with implicit bias. Parents may contribute, among many others, to the stigmatizing environment experienced by youth with overweight/obesity, which has been associated with negative child psychosocial functioning and health. Clinical research into strategies to reduce parental weight bias against children with obesity or increase children’s resilience to weight discrimination is needed to improve children’s health and well-being.     

Association of parental psychological and behavioral factors and children's syncope.

The authors examined the associations between parental variables and child syncope (fainting). Children ages 7 to 18 years undergoing tilt-table testing for neurocardiogenic syncope (NCS) at a pediatric cardiac center served as participants (N = 56). Results revealed that fathers' shortness of breath and overall psychological distress were significantly related to syncope frequency and emergency room (ER) visits for girls. Mothers' overall psychological distress, depressive symptoms, and shortness of breath were associated with boys' frequency of syncope and ER visits. Fathers' psychological factors were highly correlated with syncope for the children diagnosed negative for NCS. The frequency of children's syncope was higher in stepfamilies than in homes with both biological parents, and the correlations between children's syncope and the stepfathers' psychological symptoms were greater than for the children and their biological fathers in intact families. The role of parental psychological factors on child syncope is supported.     

Parent ratings of children's depression,anxiety, and aggression: A cross-sample analysis of agreement and differences with child and teacher ratings

Parent ratings of depression, anxiety, and aggression in elementary school and impatient 8- to 12-year-olds were evaluated by examining their correspondence and discrepancies with parallel child and teacher ratings. Parent-child and parent-teacher correspondence was significantly better for elementary school than inpatient children on depression and anxiety. Parents and teachers reported similar levels of symptoms on all traits for elementary school children, yet parents reported significantly more symptoms than teachers in the inpatient sample. The level or severity of anxiety symptoms that parents reported in inpatient children was similar to that reported by children, yet inpatient children reported significantly less depression and aggression than parents. Elementary school children reported significantly more symptoms on all traits than parents. Age, sex, and sample differences in discrepancies were examined. © 1996 John Wiley & Sons, Inc.     

乙型肝炎患儿父母心理健康状况对照研究

采用“家长生活调查问卷”对广州市就读专收ＨＡＡ阳性幼儿园的父母、未有就读任何幼儿园ＨＡＡ阳性儿童的父母、以及就读普通幼儿园健康儿童父母进行了调查，结果发现ＨＡＡ阳性儿童的父母由于承受较大的心理压力而出现更多的心理问题、这种压力影响到父母的身心健康。资料为社会保健提供了依据。     

Children's coping strategies and coping efficacy: relations to parent socialization, child adjustment, and familial alcoholism

The relations of children's coping strategies and coping efficacy to parent socialization and child adjustment were examined in a sample of school-age children that included families in which some of the grandparents and/or parents had an alcoholism diagnosis. Parents and older children reported on the children's coping strategies; parents reported on their parenting behavior; and teachers reported on children's externalizing and internalizing problems. Measures of parent socialization were associated with parents' and children's reports of active coping strategies and parents' reports of both support-seeking coping and coping efficacy. Some of these relations were moderated by familial alcohol status. Children higher in parent-reported active/support-seeking coping and coping efficacy were rated lower in teacher-reported externalizing and internalizing adjustment problems. The findings were consistent with the view that active/support-seeking coping and coping efficacy mediated the association of parent socialization to children's psychological adjustment and that this relation was sometimes moderated by parental alcohol status.     

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.     

Things that Go Bump in the Night: Frequency and Predictors of Nightmares in Anxious and Nonanxious Children

Frequency and predictors of nightmares among children 7–11 years old with generalized anxiety disorder (GAD; n = 42) and no diagnosis (n = 44) were examined using both prospective and retrospective child and parent reports. Both children with GAD and their parents reported significantly more nightmares than controls based on retrospective reports, but the groups did not differ when nightmares were assessed daily across a one-week prospective period. Females reported more nightmares than males according to prospective assessment only. Controlling for sex and group, child sleep anxiety and presleep somatic arousal predicted parent but not child report of nightmares. Results suggest both clinically anxious youth and their parents overestimate the occurrence of nightmares, yet factors influencing retrospective accounts appear to differ across informants.