Family conflict moderates response to pharmacological intervention in pediatric bipolar disorder

OBJECTIVE: Family conflict affects the expression of psychopathology in youth. This study investigated whether family conflict moderates response to medication in youth with bipolar disorder. METHODS: Youth ages 5-17 years diagnosed with bipolar I or II disorder were recruited from a trial of combination therapy with divalproex and lithium. Mania and depression were assessed at baseline and after 8 weeks of treatment using the Young Mania Rating Scale (YMRS) and the Children's Depression Rating Scale-Revised (CDRS-R). Parents completed the Family Assessment Device (FAD). Ordinary least-squares regression evaluated whether family conflict contributed to YMRS/CDRS-R outcomes controlling for severity of baseline mood. RESULTS: In 55 youths, the model examining family conflict and CDRS-R outcomes showed that family conflict variables accounted for 10% of the variance in CDRS-R scores after 8 weeks of treatment. The final model was statistically significant. The FAD Problem Solving subscale was the only uniquely significant predictor of CDRS-R scores after 8 weeks of treatment. Family conflict did not predict YMRS outcomes. CONCLUSION: There is a significant relationship between family problem solving and depressive symptoms that persist despite pharmacotherapy. Although depression severity was mild at baseline, it persisted despite pharmacological treatment in youths whose families endorsed higher levels of conflict.     

A randomized, controlled evaluation of early intervention: the Born to Learn curriculum

Background   This study addressed the need for studies of the efficacy of the Born to Learn (BTL) curriculum.
Methods   Based on random assignment, 227 families of infants received the BTL curriculum conducted in monthly home visits, and 237 families received general child development education only.
Results   The BTL curriculum resulted in higher mastery motivation (task competence) at 36 months ( P  < 0.05) and greater effects for children from low ( P  < 0.01) versus high socio-economic status on mastery motivation and cognitive development at 24 months. No effects were found on a wide range of other developmental outcomes.
Conclusion   Future studies should document the BTL curriculum effectiveness in diverse settings and samples.     

The Influence of Parental Supervision on Medical Adherence in Adolescents With Cystic Fibrosis: Developmental Shifts From Pre to Late Adolescence

Previous research suggests that both parental supervision and adherence decrease in adolescence, as the drive for independence and autonomy emerge naturally during this developmental period. The current study evaluated relationships between patient-reported parental supervision and adherence in 103 preadolescents and adolescents with cystic fibrosis (CF). Activity patterns (medical and nonmedical) were measured using the daily phone diary (DPD) and adherence to nebulized medications was measured electronically. Age was strongly related to amount of supervision, with less supervision provided for older adolescents. Further, preadolescents and adolescents who spent more of their treatment time supervised by parents, particularly mothers, had better adherence.     

Editorial: Acknowledging the Extraordinary Service and Contributions of the Editorial Board for the Journal

Starting with the first issue of 2008, the Journal of PediatricPsychology, (JPP) will have a new editorial board with a 3-yearterm. This change was accomplished to recognize the work     

Schoolteachers' Experiences With Childhood Chronic Illness

The objective of this study was to examine the degree to which educators face problems associated with chronic illness in their pupils, the extent to which they feel responsible for addressing such problems, and the amount of training to deal with these problems. One hundred schools randomly selected from 10 counties in a midwest state stratified on substance abuse deaths, mental health costs, and socioeconomic status (percentage of free lunches) were approached, and 17 agreed to participate. Of the 1, 184 eligible educators, 480 provided complete surveys (response rate = 40%). Nearly every respondent (98.7%) reported knowing a student in the school with a chronic illness, and 43% felt moderately to very responsible for dealing with issues of chronic illness, yet 59% reported no academic training and 64% reported no on-the-job training for dealing with issues of chronic illness. Schoolteachers are ill-prepared to deal with issues of chronic illness in the schools. Practice implications are discussed.     

Personality adjustment of children and adolescents with hypopituitarism

Sixteen children and adolescents with extreme short stature secondary to hypopituitarism were compared to a matched group of physically healthy peers on a variety of psychological tests assessing general adjustment, body image, sex role development, sex-related fantasy, and reactions to frustration. With the exception of their reactions to frustrations, the psychological adjustment of children with hypopituitarism compared favorably with that of normal children. Children with hypopituitarism typically perceived less adaptive, mature solutions to frustrating situations than did peers of average stature. Anticipatory guidance for children with extreme short stature might help facilitate more adaptive responses to the difficult and inevitable frustrations imposed by short stature. Evaluations of intervention directed toward the enhancement of coping skills and life adjustment of children with small stature due to hypopituitarism is seen as a focus for future research with this population.