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Preview: Journal of Pediatric Psychology - current issue

Journal of Pediatric Psychology - current issue

Journal of Pediatric Psychology - RSS feed of current issue




Parent Perceptions of Illness Uncertainty and Child Depressive Symptoms in Juvenile Rheumatic Diseases: Examining Caregiver Demand and Parent Distress as Mediators


Objective Examine caregiver demand and general parent distress as mediators in the parent illness uncertainty—child depressive symptom association in youth with juvenile rheumatic diseases. Methods Children and adolescents completed the Child Depression Inventory; caregivers completed the Parent Perceptions of Uncertainty Scale, the Care for My Child with Rheumatic Disease Scale, and the Brief Symptom Inventory. The pediatric rheumatologist provided ratings of clinical disease status. Results Analyses revealed significant direct associations between illness uncertainty and caregiver demand, and between caregiver demand and both parent distress and child depressive symptoms. Results also revealed significant parent uncertainty -> caregiver demand -> parent distress and parent uncertainty -> caregiver demand -> child depressive symptom indirect paths. Conclusions Results highlight the role of illness appraisals in adjustment to juvenile rheumatic diseases, and provide preliminary evidence that parent appraisals of illness uncertainty impact parent distress and child depressive symptoms indirectly through increased perceptions of caregiver demand.

Neighborhood Stress, Depressive Symptoms, and Asthma Morbidity in Youth


Objective Living in a dangerous and disadvantaged neighborhood is consistently linked with poor health outcomes; however, few studies have investigated psychosocial mechanisms of this relationship. We hypothesized that a specific facet of depression—anhedonia—would partially explain the relationship between stressful neighborhoods and poor health in youth with asthma. Method 156 youths provided reports on their depressive symptoms, daily asthma symptoms, and peak expiratory flow rate (PEFR). Caregivers provided reports on neighborhood characteristics. Results Youth residing in more at-risk neighborhoods experienced more symptoms of depression, greater asthma symptoms (both during the day and night), and marginally lower PEFR. Indirect effect analyses revealed that the relationship between neighborhood stress and youth asthma symptoms was partially explained by a key symptom of depression, anhedonia. Conclusions These findings suggest that the neighborhood-health link is partially explained by symptoms of depression tapping into difficulties experiencing pleasure and motivation.

Maternal Depressive Symptoms and Household Income in Relation to Sleep in Early Childhood


Objective Sleep health is critical for children to adapt to evolving cognitive-socioemotional contexts. Given that sleep timing in early childhood is instituted under caregiver control, the family context likely has an influential role on children’s sleep. This study investigated links between maternal depressive symptoms and variability in children’s sleep, and whether household income moderated this relation. Method 90 children (Mage = 53 ± 9 months) wore actigraphs to objectively measure sleep for 4–16 days. Mothers reported income and depressive symptomatology. Results Higher maternal depressive symptoms were related to greater variability in 24-hr sleep duration. Income moderated this relation. Lower income, but not maternal depressive symptoms, was linked to greater variability in sleep onset time. Conclusions Findings demonstrate important relations between maternal depressive symptoms, income, and children’s sleep. Understanding distal and proximal family characteristics that may be related to children’s developing sleep schedules could help identify populations and strategies for promoting optimal sleep health.

Childhood Bedtime Problems Predict Adolescent Internalizing Symptoms Through Emotional Reactivity


Objective Sleep problems are frequent in children and robustly predict internalizing symptoms in adolescence and adulthood. Longitudinal investigations have nonetheless used broad measures of childhood sleep problems, precluding understanding of the specific sleep problems that presage affective disturbances. Similarly, prospective examinations of mechanistic variables linking early sleep with subsequent internalizing symptoms are lacking. Method Childhood bedtime and nighttime waking problems were examined as independent predictors of adolescent internalizing symptoms within a community sample from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,089). The mediational role of emotional reactivity in late childhood also was examined. Results Bedtime but not nighttime waking problems significantly predicted adolescent internalizing problems. This relationship was partially explained by child emotional reactivity. Conclusions Some childhood sleep problems may more reliably predict later internalizing symptoms than others. Temperamentally based emotional reactivity may potentiate affective risk associated with childhood sleep difficulties.

Daily Bidirectional Relationships Between Sleep and Mental Health Symptoms in Youth With Emotional and Behavioral Problems


Objective The present study examined the daily, bidirectional relationships between sleep and mental health symptoms in youth presenting to mental health treatment. Methods Youth aged 6 to 11 (36% female, 44% European American) presenting to outpatient behavioral health treatment (N = 25) were recruited to participate in the study. Children and parents completed daily questionnaires regarding the child’s sleep, mood, and behavior for a 14-day period, while youth wore an actigraph watch to objectively measure sleep. Results Examining between- and within-person variance using multilevel models, results indicate that youth had poor sleep duration and quality and that sleep and mental health symptoms were highly related at the daily level. Between-person effects were found to be most important and significant bidirectional relationships exist. Conclusions Identifying and addressing sleep problems in the context of mental health treatment is important, as poor sleep is associated with increased symptomology and may contribute to worsened mental health.

An Evaluation of the Childrens Report of Sleep Patterns Using Confirmatory and Exploratory Factor Analytic Approaches


Objective To explore the psychometric properties of the Children’s Report of Sleep Patterns (CRSP) in school-aged children by conducting a factor analysis of the Sleepiness Scale and the Sleep Disturbances Scales. Methods Participants included 155 children from two elementary schools (Mage = 9.82) who completed the self-report CRSP. A confirmatory factor analysis (CFA) was conducted using the originally hypothesized structure. A subsequent exploratory factor analysis (EFA) was conducted to determine an alternative factor structure. Results CFA revealed that the hypothesized factor structure was not supported. The EFA produced an alternative six-factor solution, which supports the conceptualization of three new scales, Restless Legs Report, Sleep Initiation, and Sleep Maintenance/Night Wakings. Conclusion The revised measure adds increased specificity with scales related to insomnia and restless leg symptoms. Researchers and clinicians interested in using the CRSP should continue to assess its validity by exploring the relationship between the measure and objective measures of sleep behavior.

Stressful Events in Early Childhood and Developmental Trajectories of Bedwetting at School Age


Objective To examine whether early stressful events are associated with developmental trajectories of bedwetting. Methods This is a prospective cohort study comprising 8,761 participants from the Avon Longitudinal Study of Parents and Children. Stressful events were measured using a maternal questionnaire completed at 3 time points before their child was 4 years old. The association between stressful events and trajectories of bedwetting from 4 to 9 years was examined using multinomial regression. Results The association with stressful events was strongest for the frequent persistent bedwetting trajectory (wetting at least twice a week up to age 9). A 1 standard deviation increase in the stressful events score was associated with a 29% (13–47%) increase in the odds of experiencing frequent persistent bedwetting compared with normal attainment of nighttime bladder control. Conclusions Clinicians and parents should be aware that continence is a developmental outcome that is associated with high levels of stress in the family.

Trajectories of Health-Related Quality of Life Among Children With Newly Diagnosed Epilepsy


Objective To identify two-year trajectories of health-related quality of life (HRQOL) among children with newly diagnosed epilepsy, and evaluate key predictors of HRQOL trajectories. Methods This study is part of a prospective study of adherence and HRQOL outcomes in children with epilepsy. Caregivers completed an HRQOL questionnaire at one month post diagnosis and every three months thereafter for two years. Chart review and additional questionnaires were used to collect medical variables and seizure outcomes. Results Participants included 120 children with epilepsy and their caregiver. Unique trajectories for overall HRQOL and PedsQL™ subscales were identified and were predominantly stable. A total side effects score emerged as a consistent predictor of all HRQOL domains. Other variables (i.e., socioeconomic status, seizures, internalizing and externalizing problems) uniquely predicted HRQOL domains. Conclusions Medical and psychosocial interventions should be implemented soon after treatment initiation to target modifiable factors (e.g., side effects, anxiety symptoms), which could improve HRQOL.

Adolescents Spirituality and Cystic Fibrosis Airway Clearance Treatment Adherence: Examining Mediators


Objective Adolescent cystic fibrosis (CF) treatment adherence is a significant multidimensional issue. Using the Theory of Reasoned Action (TRA), this study examined the role of spiritual factors in adherence. Methods Forty-five 11–19-year-olds diagnosed with CF completed questionnaires concerning psychosocial, spiritual, and adherence-related constructs and Daily Phone Diaries to calculate treatment adherence. Exploratory Factor Analysis identified two spiritual factors used in subsequent analyses. The mediating roles of attitude toward the treatment’s value (utility), subjective behavioral norms (the product of perceived behavioral norms and one’s motivation to comply with them), self-efficacy for completing the treatments and treatment intentions in the relationship between spiritual factors and treatment adherence were tested with path analysis. Results Lower ‘spiritual struggle’ and greater ‘engaged spirituality’ predicted treatment attitude (utility) and subjective behavioral norms, which, together with self-efficacy, predicted treatment intentions. Finally, treatment intentions predicted airway clearance adherence. Conclusions Findings were consistent with the TRA. Engaged spirituality supports pro-adherence determinants and behavior. Spiritual struggle’s negative associations with outcomes warrant screening and intervention.

Adaptation of the State-Trait Inventory for Cognitive and Somatic Anxiety for Use in Children: A Preliminary Analysis


Objective Anxiety has both state/trait and cognitive/somatic dimensions, and these distinctions may be particularly relevant for children with medical problems. This two-part study adapted the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and confirmed its factor structure in a sample of children in a primary care clinic. Methods STICSA items were adapted for reading level and piloted in a small group of children. Next, 250 children (12.3 ± 2.7 years) completed the adapted version, the STICSA-C. Results Separate confirmatory factor analyses conducted on the State and Trait forms of the STICSA-C confirmed the two-factor structure of the original measure (i.e., cognitive and somatic anxiety) and suggested an improved parsimonious model. Conclusions Support was found for use of the STICSA-C as a reasonably good internally consistent measure for assessing cognitive and somatic anxiety in pediatric samples. Further investigation of its reliability and validity with replication in pediatric populations is warranted.