Case Reports in Pediatric Psychology: Uses and Guidelines for Authors and Reviewers

Described uses of case reports in pediatric psychology and guidelinesfor authors and reviewers. Case reports have several importantfunctions: to document the efficacy of new treatment applications,describe interesting new clinical phenomena, to develop hypotheses,to illustrate methodological issues, difficult diagnostic issues,or novel treatment approaches, and to identify unmet clinicaland research needs. Authors should carefully document the scientificpurpose and clarify the new information contributed by theirreports, provide evidence for their conclusions, and articulateclinical, theoretical, and/or research implications.     

Relationship of microbial activity andCeriodaphnia responses to mining impacts on the Clark Fork River,Montana

An evaluation of an aquatic toxicity test battery was conducted on the metal polluted Clark Fork River, in western Montana. The test battery included the 7-dayCeriodaphnia survival-reproduction assay and 12 microbial assays of enzyme activity, heterotrophic uptake, and metal resistance in sediments and/or waters. Surrogate tests were evaluated for effectiveness at detecting toxicant impacts by comparing their response with stream parameters, including diatoms and metal concentrations. Several statistically significant correlations were observed between surrogate profiles and stream profiles, which verified toxicant impacted areas of the stream. The short-term test battery proved to be valid and allowed evaluation of impacts to both periphyton and microbial processes.     

Knowledge of physician prescriptions and adherence to treatment among children with cystic fibrosis and their mothers.

This investigation examined factors related to adherence to treatment regimens for children with cystic fibrosis (CF) and their mothers. Subjects were 45 children with CF who ranged in age from 6 to 10 years and their mothers. Findings revealed that children's and parents' reports of level of adherence were related to their knowledge of the specific details associated with medically prescribed treatments. In this sample, 12% to 32% of mothers did not have an accurate understanding of physician recommendations for their children's treatments. When controlling for individual differences in the prescribed treatment regimens, parents' and children's knowledge of what had been prescribed accounted for a significant portion of the variance in the children's reported treatment-related behaviors. Results are discussed in terms of implications for future intervention research aimed at enhancing adherence to treatment as well as for future directions for clinical efforts in this area.     

The diagnostic and statistical manual for primary care (DSM-PC), child and adolescent version: what pediatric psychologists need to know.

OBJECTIVE: To address the need for a comprehensive, developmentally appropriate method to facilitate primary care pediatricians' recognition, management, and referral of a wide spectrum of childrens' behavioral and developmental problems, as well as stressful situations. METHODS: Use of the Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version can facilitate psychologists' abilities to conduct research concerning the prevalence of behavioral and developmental problems, describe collaborative practice in primary care, and train pediatricians to recognize and manage common behavioral and developmental problems. CONCLUSIONS: Strategies to enhance utilization of the DSM-PC include more widespread dissemination of information concerning the manual and its practical utility, promotion of reimbursement for its use, and documenting applications of the DSM-PC in teaching, practice, and research.     

Development and validation of the Child Activity Limitations Interview: a measure of pain-related functional impairment in school-age children and adolescents

Recurrent pain in childhood are common and frequently impact children's everyday functioning. However, there are currently limited tools available to measure the impact of recurrent pain on children's daily activities, in particular, that can be used to identify appropriate targets for intervention and measure response to such interventions. The purpose of this study was to develop and validate a new measure, the Child Activity Limitations Interview (CALI), to improve the assessment of functional impairment due to recurrent pain in school-age children and adolescents, and to compare this measure to the Functional Disability Inventory. Participants included 189 children, aged 8-16 years (M=12.4, SD 2.5), 60% female, 40% minority, who were part of a longitudinal study of recurrent pain in children with headaches, juvenile idiopathic arthritis, and sickle cell disease. Measures of socio-demographics, pain, anxiety and depression, and functional disability were completed. A subset of participants (47%) were re-administered the CALI 1 month later and completed prospective ratings of pain and activity limitations using the CALI in daily diaries. Internal consistency of the CALI was excellent (alpha=0.88, child version; alpha=0.95, parent version). One-month test-retest reliability (r = 0.33, child report) and cross-informant reliability (r = 0.43) were moderate. Results demonstrate support for face, construct, and concurrent validity as well as responsiveness to pain symptom fluctuation. Findings demonstrate that the CALI is a promising measure for assessing and monitoring subjective report of functional impairment in school-age children and adolescents with recurrent and chronic pain.     

Benchmarks for work performance of pediatric psychologists

Objective To establish benchmarks for work performance of pediatricpsychologists. Methods All full members of the Society of PediatricPsychology, Division 54 of the American Psychological Association(N = 1043), were recruited for participation in a mail survey.Four hundred and seventy surveys were returned (45%); 356 usablesurveys (34%) were included in the analyses. Surveys assessedwork-settings, academic appointments, salary, performance expectationsand evaluations, and satisfaction. Results Most of the surveyrespondents, 63%, worked in a hospital setting. On average,survey respondents were directly accountable for generatinghalf, 52%, of their salary. Salary covered by institutions wasmost frequently provided for nonrevenue generating activitiessuch as administration and teaching. Most of the sample (78%)indicated clear performance expectations and criteria. ConclusionsFindings update and expand previously established benchmarksfor work performance and have implications for the practiceof pediatric psychology in an ever-changing health care environment.     

Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain

OBJECTIVE: To examine the longitudinal relationship between depressive symptoms at study entry (T1) on pain intensity (PI) and functional disability over a 1-year period among children with either sickle cell disease (SCD) or juvenile idiopathic arthritis (JIA). METHODS: 119 children, ages 8-17 years, completed measures of depression at T1 as well as pain and functional disability at T1, 6-month (T2), and 12-month (T3) follow-ups. Caregivers also rated their child's pain and disability at each time point. General linear mixed modeling was employed to examine longitudinal relationships between study variables. RESULTS: For children with JIA, T1 pain significantly moderated the effects of T1-depressive symptoms on T2 and T3 pain where T1-depressive symptoms predicted future child-reported pain only when T1 pain was relatively mild. Similarly, T1-depressive symptoms predicted future child-reported disability only when initial reports of disability were relatively low. Only family income significantly predicted T2 and T3 pain in children with SCD. CONCLUSIONS: Study findings suggest that T1-depressive symptoms play a role in the longitudinal course of pain symptoms in children with JIA but not in children with SCD.     

Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders

This study examined health-related quality of life (HRQOL) and adjustment among children with eosinophil-associated gastrointestinal disorders (EGID) compared with an age-matched sample without acute or chronic illness. Participants were youths aged 2 to 18 years. Children and caregivers completed measures of psychological symptoms and HRQOL. Significant group differences were found for child report of depressive, as well as anxiety, symptoms. Significant group differences were also found for caregiver report of psychological symptoms and social skills. Finally, based on parent and youth report, HRQOL and greater school absenteeism were associated with EGID diagnosis.     

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.     

The adaptation of parents to the birth of an infant with a congenital malformation: a hypothetical model.

To determine the course of parental reactions to the birth of a child with a congenital malformation and the process of parental attachment, the parents of 20 children with a wide range of malformations including mongolism, congenital heart disease, and cleft palate were interviewed. Structured interviews took place 7 days to 60 months after birth. Despite the wide variation of malformations, analysis of the interviews demonstrated five stages of parental reactions--shock, denial, sadness and anger, adaptation, and reorganization--in dealing with a congenitally malformed child during the course of his development and care. Observations of these patients suggest that early crisis counseling in the first months of life may be particularly crucial in parental attachment and adjustment.