Shared dilemmas of research and practice in developmental and behavioral pediatrics: introduction to the special issue on methodology.

Research in developmental and behavioral pediatrics is characterized by special methodological problems involving measurement, design, and analysis related to research questions, populations, and nature of interventions in this field. To sensitize researchers and practitioners to these problems and to enhance the quality of research and critical consumption of research reports, this special issue provides a summary of basic methodological issues in developmental and behavioral pediatrics. Advances in this field will require the kind of critical observation and decision making that are shared by researchers and practitioners and are illustrated by contributions to this issue.     

Coming of age: critical challenges to the future development of pediatric psychology

Described five professional challenges that will affect the future development of pediatric psychology: specialization and professional identity, relationships with other professions, securing resources necessary for effective functioning, the conflict between clinical service delivery and prevention, and development of training models. To meet these challenges, pediatric psychologists need to maintain strong connections with other psychologists, develop new models of collaborative training, practice, and research, emphasize prevention activities, and enhance the scientific basis of pediatric psychology through innovative training programs and support for faculty development.     

Interpersonal stressors and resources as predictors of parental adaptation following pediatric traumatic injury

The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the initial evaluation, and at an extended follow-up with a mean of 4 years postinjury. General linear model analyses provide support for both main and moderating effects of stressors and resources on parental adjustment. Support from friends and spouse was associated with less psychological distress, whereas family and spouse stressors were associated with greater distress. The results also reveal a marked decline in injury-related stress over follow-up for families in the severe TBI group who reported a combination of high stressors and high resources. The decline suggests that interpersonal resources attenuated long-term family burden because of severe TBI. The findings are discussed in terms of their implications for intervention following TBI.     

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.     

Psychological Research with Pediatric Conditions: If We Specialize, Can We Generalize?

Considered threats to validity and generalizability of psychologicalresearch with pediatric populations and proposed ways to betterunderstand and manage these problems. Variation due to characteristicsof acute and chronic conditions (e.g., duration, severity, illnesscourse), settings and referral patterns, family environmentalcharacteristics, as well as investigators' decisions concerningcriteria and recruitment limit inferences concerning the impactof pediatric conditions on psychological development and generalizabilityof findings. These problems call for an expanded use of replication,cross-center, population-based, and theory-driven research.Scientific progress will be made by increasing dialogues andcollaboration among researchers concerning generalizabilityproblems and improving research training in epidemiologicalmethods, analysis of large-scale data sets, and meta-analysis.     

Impact of Parental Health Problems on Children: Concepts, Methods, and Unanswered Questions

Described conceptual and methodological issues that arise inthe design and analysis of data from studies of the impact ofparental health problems on children. Researchers should considerhow the functional effects, duration, and type of exposure ofparental health problems affect children's psychological experience.Multiple pathways (e.g., parental modeling, family socializationpractices, and genetic factors) that affect the transmissionof psychological and/or health risk to children need to be considered.Important methodological issues in this area of research includesample selection and bias, confounding factors, and limitedassessment of family influences. Future work should identifyfactors that enhance child and family resilience to the effectsof parental health problems. Studies are also needed to developand test interventions to reduce the psychological morbidityassociated with parental health problems.     

Correlates of psychosocial adjustment among young adults with cystic fibrosis

Young adults with cystic fibrosis (CF) (n = 73) were found to have age-adequate psychological functioning. Psychological adjustment, as measured by the Psychological Screening Inventory (PSI) and the Tennessee Self-Concept Inventory (TSCI), correlated with coping style as measured by the Repression-Sensitization (R-S) scale. A repressive or avoidant coping style was associated with higher self-esteem, lower alienation and discomfort, and greater social activity, but not with employment status or school attendance. Severely ill patients were less likely to be employed or in school, and showed higher levels of psychological discomfort. Physicians' ratings of coping effectiveness were positively related to a repressive illness-related coping style. Prospective assessment of psychological functioning would yield useful information concerning the coping strategies used by young adults with CF to ameliorate the psychological distress associated with physical deterioration.     

Child and family functioning 6 and 12 months after a serious pediatric fracture

BACKGROUND: Previous findings indicate that pediatric fractures can have adverse consequences for child adjustment and family functioning immediately after injury. However, longer term effects of the fractures are unknown. The purposes of the present prospective study were to examine the child and family outcomes of pediatric traumatic fractures at 6 months and 1 year after injury, and to identify injury and treatment factors associated with these outcomes. METHODS: We evaluated 57 children 6 to 12 years of age with traumatic fractures requiring hospitalization. Using standardized measures and parent interview, we obtained measures of pre- and postinjury child and family functioning. RESULTS: Although outcomes were primarily positive at 1 year after injury, child functional limitations and family stress were observed up to 6 months after injury. Lower extremity fractures had a more negative impact on families across all three assessment points. Children with fracture interventions that involved prolonged immobilization had more functional limitations at 6 months than children who were ambulatory. Family burden was higher at 1 month for the immobilized children, but not at later follow-up. CONCLUSION: Some children and families experience adverse effects during the year after a serious pediatric fracture, especially if sustained in a lower extremity. Fracture stabilization that allows for greater ambulation may offer some benefits related to functional outcomes and family impact.     

Cognitive functioning in children on dialysis and post-transplantation

We studied 124 children, 62 patient-subjects who had end-stage renal disease (ESRD) and 62 sibling-controls who closely matched the patient-subjects in terms of their ethnicity and their socioeconomic status, to discern whether children with ESRD would perform less well than their siblings on standardized achievement and intelligence quotient (IQ) tests, and to determine whether ethnicity would influence such results. The subjects were recruited from nine pediatric transplant and dialysis centers across the United States. Thirty-one subjects were white (Euro-American), 17 were African-American, and 14 were categorized as 'other'. The average age of the patient-subjects was 13.7 +/- 0.44 yr; and of the sibling-controls 13.7 +/- 0.38 yr. Most patients (61%) and siblings (84%) were in regular school classes, and most (87% and 92%, respectively) attended school full-time. The average IQ percentile rank for the patients was significantly lower than their siblings (31 +/- 4 vs. 44 +/- 5, respectively, with normal = 50). Patients tended to score lower on achievement tests compared with their siblings (spelling: 88.7 +/- 4 vs. 94.6 +/- 2; arithmetic: 88.5 +/- 2 vs. 94.0 +/- 2; reading: 91.9 +/- 2 vs. 100 +/- 3, respectively). Patients scores on achievement tests were influenced by age at diagnosis and by the mother/caregiver's lower achievement. Also, increased time on dialysis predicted lower scores on achievement tests. Neither dialysis/transplant status nor ethnicity significantly affected outcome. Our data suggest that ESRD, but not ethnicity or dialysis/transplant status, is a risk factor for lower IQ and academic achievement, especially in younger children, in children who spend more time living with ESRD, and in children whose mother's/caregiver's have lower educational levels.