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Preview: Journal of Pediatric Psychology - Advance Access

Journal of Pediatric Psychology Advance Access





Published: Mon, 18 Sep 2017 00:00:00 GMT

Last Build Date: Mon, 18 Sep 2017 11:49:32 GMT

 



The Comfort Ability Pain Management Workshop: A Preliminary, Nonrandomized Investigation of a Brief, Cognitive, Biobehavioral, and Parent Training Intervention for Pediatric Chronic Pain

2017-09-18

Abstract
Objective
Psychological intervention is widely recognized as an integral part of the recovery process from pediatric chronic pain, but service acquisition is often limited by resource barriers. The aim of this study was to assess the feasibility, acceptability, and satisfaction of a brief, structured, skills-based, group intervention designed expressly to address gaps in service delivery. Exploratory outcomes were also assessed.
Method
Adolescents with chronic pain (n = 102; ages 10–17 years) and their mothers (n = 105) completed self-report questionnaires at baseline, 1-week, 1-month, and 3-month posttreatment.
Results
This study demonstrated feasibility, and overall high acceptability and satisfaction among adolescents and parents. Exploratory analyses within this nonrandomized design suggest that adolescents demonstrate improvement in functionality (p = .0012), depression symptoms (p < .0001), and pain catastrophizing (p < .0001) by 1-month posttreatment and continued making gains over time. Parents made significant changes in parenting practices (p-values < .01) and in their beliefs about their adolescent’s ability to manage pain (p < .001) by 1-week posttreatment and continued making gains over time.
Conclusions
This brief intervention is both feasible and acceptable. Although small effect sizes were found for all outcome measures, parents and adolescents made significant gains postintervention. In the absence of a direct comparison group, we cannot determine if these improvements are exclusively attributable to the intervention. Future research will be needed to understand the degree to which this brief intervention may effectively enhance the attainment of evidence-based psychoeducation and cognitive behavioral skills that are known to foster adaptive parent and adolescent responses to chronic pain.



Altered Neurophysiological Processing of Auditory Attention in Preschool Children With Sickle Cell Disease

2017-09-18

Abstract
Objective
Sickle cell disease (SCD) is a genetic red blood cell disorder that often leads to stroke and executive dysfunction in school-age children and adults. This study aimed to characterize the development of the neural correlates of selective attention, an early component of executive function, in preschool children with SCD.
Methods
Auditory event-related potentials (ERPs) were recorded while children attended to a story stream in one ear and ignored a second story in the other ear interchangeably. In total, 12 patients (mean age = 5.5, 7 males) and 22 typically developing children (mean age = 4.4, 10 males) were included in the final analyses.
Results
By 100 ms, more positive ERP amplitudes were observed for attended relative to unattended stimuli in typically developing children but not those with SCD, suggesting deficits in the ability to focus attention. Reduced attention effects were associated with lower performance intellectual quotient
Conclusion
There are deficits in early attention modulation in young children with SCD.



Community Crime Exposure and Risk for Obesity in Preschool Children: Moderation by the Hypothalamic–Pituitary–Adrenal-Axis Response

2017-09-18

Abstract
Objective
Identification of early risk factors related to obesity is critical to preventative public health efforts. In this study, we investigated links between the Hypothalamic–Pituitary–Adrenal (HPA)-axis activity (diurnal cortisol pattern), geospatially operationalized exposure to neighborhood crime, and body mass index (BMI) for a sample of 5-year-old children. Greater community crime exposure and lower HPA-axis activity were hypothesized to contribute to higher BMI, with child HPA-axis moderating the association between crime exposure and BMI.
Method
Families residing within the boundaries of the City of Seattle (N = 114) provided information concerning demographic/psychosocial risk factors, used to calculate a Cumulative Risk Index, indicating the number of contextual adversities present. Child BMI and diurnal cortisol pattern (derived from assays of saliva samples) were examined, along with neighborhood crime indices computed with publically available information, based on participants’ locations.
Results
Hierarchical multiple regression analyses, adjusted for covariates (cumulative risk, age, and sex), indicated that crime proximity made a unique contribution to child BMI, in the direction signaling an increase in the risk for obesity. Consistent with our hypothesis, a significant interaction was observed, indicative of moderation by diurnal cortisol pattern. Follow-up simple slope analyses demonstrated that crime exposure was significantly related to higher BMI for children with low-flat (blunted) diurnal cortisol patterns, where community crime and BMI were not significantly associated at higher levels of cortisol.
Conclusion
Community crime exposure contributes to higher BMI as early as the preschool period, and blunted diurnal cortisol patterns may place children experiencing neighborhood adversity at greater risk for obesity.



Evidence of Disturbed Sleep in Children With Eosinophilic Esophagitis and Persistent Epigastric Pain

2017-09-15

Abstract
Objective
To determine whether the experience of persistent epigastric pain is associated with sleep disturbances in children with eosinophilic esophagitis (EoE). We hypothesized that children with EoE and persistent epigastric pain would (1) self-report greater current and worst pain severity, and (2) experience more disturbed sleep on objective and subjective measures in comparison with children with EoE but no persistent pain and healthy children.
Methods
Fifty children with EoE were recruited for this cross-sectional study, of which 24 (48%) reported experiencing persistent epigastric pain. The remaining 26 (52%) children with EoE denied experiencing persistent pain. An additional 25 healthy children without EoE or persistent pain were included. All children provided severity ratings of current pain and worst pain experienced over the past week. Children then completed 12 consecutive nights of ambulatory sleep monitoring via actigraphy in the home. Caregivers provided information regarding their child’s sleep patterns and internalizing symptoms.
Results
Children with EoE and persistent pain reported significantly greater severity of current pain (p < .001) and worst pain over the past week (p < .001) compared with EoE without persistent pain and healthy children. Compared with the other groups, children with EoE and persistent pain also demonstrated greater actigraphic sleep disturbances, lower sleep efficiency (p = .004) and greater wake after sleep onset (p = .034).
Conclusions
This study provides novel evidence that a significant proportion of children with EoE experience persistent symptoms of epigastric pain. Persistent pain was associated with significant sleep disturbances in children with EoE.