Objective: To describe the prevalence of acute stress disorder (ASD) symptoms and to examine proposed "DSM-5" symptom criteria in relation to concurrent functional impairment in children and ...adolescents. Method: From an international archive, datasets were identified that included assessment of acute traumatic stress reactions and concurrent impairment in children and adolescents 5 to 17 years of age. Data came from 15 studies conducted in the United States, United Kingdom, Australia, and Switzerland and included 1,645 children and adolescents. Dichotomized items were created to indicate the presence or absence of each of the 14 proposed ASD symptoms and functional impairment. The performance of a proposed diagnostic criterion (number of ASD symptoms required) was examined as a predictor of concurrent impairment. Results: Each ASD symptom was endorsed by 14% to 51% of children and adolescents; 41% reported clinically relevant impairment. Children and adolescents reported from 0 to 13 symptoms (mean = 3.6). Individual ASD symptoms were associated with greater likelihood of functional impairment. The "DSM-5" proposed eight-symptom requirement was met by 202 individuals (12.3%) and had low sensitivity (0.25) in predicting concurrent clinically relevant impairment. Requiring fewer symptoms (three to four) greatly improved sensitivity while maintaining moderate specificity. Conclusions: This group of symptoms appears to capture aspects of traumatic stress reactions that can create distress and interfere with children's and adolescents' ability to function in the acute post-trauma phase. Results provide a benchmark for comparison with adult samples; a smaller proportion of children and adolescents met the eight-symptom criterion than reported for adults. Symptom requirements for the ASD diagnosis may need to be lowered to optimally identify children and adolescents whose acute distress warrants clinical attention. (Contains 5 tables and 1 figure.)
Objective: Adherence to treatment recommendations following medical care for pediatric conditions is important for promoting optimal physical and psychological well-being. The purpose of this ...qualitative study was to gain an understanding of the potential barriers to adherence following injuries in adolescents. Method: Ten adolescents aged 14-17 (9 male) and their parents participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded for analysis of themes related to adherence and barriers to adherence. Results: Results indicated that adolescents may encounter a number of barriers to adherence, including concern about pain medication addiction, competing activities in conflict with medical recommendations, desire for autonomy, and emotional responses to their injury and associated treatment. Conclusions: Thus, although more research is needed to better understand how these factors affect later outcomes, medical teams may want to consider facilitating discussion about potential barriers to adherence while working with adolescents and their parents to support optimal recovery.
Implications for Impact Statement
The present study suggests that adolescents encounter numerous barriers to adhering to their medical recommendations after sustaining an injury. Given the potential consequences associated with poor adherence, these barriers may contribute to the future development and evaluation of interventions to promote optimal postinjury recovery.
Indicated and selective preventive interventions Marsac, Meghan L; Donlon, Katharine; Berkowitz, Steven
Child and adolescent psychiatric clinics of North America,
04/2014, Letnik:
23, Številka:
2
Journal Article
Recenzirano
Exposure to traumatic events places children at risk for developing distressing, significant emotional reactions such as posttraumatic stress symptoms (PTSS). These reactions also affect long-term ...functional outcomes. Research on identified and potential risk factors for the development of significant, persistent PTSS is under way. Evidence for preventive interventions is in its infancy but progressing. Family-centered interventions comprising education about emotional reactions to traumatic events and focusing on communication between children and parents show promising results. Only morphine has shown sufficient evidence as a pharmacologic intervention in children. Additional research is necessary to support the establishment of gold-standard preventive practices.
The ways in which a family copes with the physical and psychosocial burdens of sickle cell disease (SCD) can influence the child and family functioning. However, few studies have examined SCD-related ...stressors beyond pain or how children and parents cope with these stressors. This study aimed to describe child coping and parent attempts to help their children cope (ie, coping assistance) with a range of SCD stressors by using a triangulated mixed methods design. We also explored convergence between findings from qualitative interviews and quantitative coping inventories. Fifteen children (aged 6 to 14 years) with SCD and their parents (N=15) completed semistructured interviews and self-report measures to assess SCD-related stressors, coping, and coping assistance strategies. Findings indicate that children experience numerous stressors related to SCD and its treatment, including, but not limited to, pain. To manage these stressors, families employ a range of approach and avoidance-oriented coping strategies. Quantitative and qualitative assessments provided complementary and unique contributions to understanding coping processes among children with SCD and their parents. Examining a broad range of stressors and integrating multiple assessment methods helps improve our understanding of coping with pediatric SCD, which may inform clinical practice and family-focused intervention development.
Objective: The objective of this study is to provide initial evaluation of the acceptability of a new eHealth system incorporating personalized self-report assessment of multiple health domains in ...school-age children and assess convergent validity of two brief measures presented via this system. Methods: Ill or injured children (N = 167) ages 6-14 recruited in two pediatric health care systems used the prototype eScreen interface on a mobile device to select an avatar and complete brief assessments of pain and posttraumatic stress symptoms (PTSS). Children rated technology acceptability and completed validated measures for pain and PTSS. Results: Children's ratings indicated they found the eScreen interface easy to use (mean rating 4.4 on a 1-5 scale), potentially useful in helping them recover (M = 3.7), and would use/recommend it (M = 4.0). Among children ages 6-8, mean ratings were as follows: easy to use (3.7), usefulness (3.3), and would use/recommend (3.4). Acceptability was largely consistent across child gender, family income, or usual access to mobile devices. eScreen measures showed strong convergent validity with established measures. The eScreen Pain Screener was highly correlated (r = .86-.92) and evidenced strong agreement with two validated pain measures. eScreen PTSS scores were strongly correlated with a validated PTSS measure (r = .67); a positive PTSS screen was associated with significantly higher PTSS severity. Conclusions: Study results support the acceptability (ease of use, intention to use/recommend, perceived usefulness) of these tools for older school-age children and provide strong initial evidence for the validity of two brief measures presented in a novel digital modality.
Implications for Impact Statement
Key parts of an adaptable eHealth screening system were rated positively by children ages 9-14; younger children's ratings suggest the need for additional development for their use. Results support the validity of brief pain and posttraumatic stress measures presented via this system and personalized with an avatar chosen by the child.
Children who sustain injuries are at risk for experiencing traumatic stress reactions. Few studies have obtained detailed, qualitative information regarding children's and parents' own understanding ...of their experiences during the peritrauma period. Understanding children's injury and early hospital experiences is crucial to inform the development of early interventions during the peritrauma period, which speak to these concerns. The primary purpose of this study was to understand child and parent views of the stressors experienced by children hospitalized for an injury. A secondary aim was to identify children's feelings and thoughts about injury- and hospital-related stressors. Ten children and their parents participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded. Stressors were classified into 5 domains: procedural concerns, uncertainty, sleep and nutrition challenges, being confined to the hospital, and home preparation. Children and parents were more likely to articulate feelings about stressors than thoughts about stressors. Feelings reported by children and parents were predominantly negative. Children and parents may have an easier time expressing feelings than thoughts, which has implications for communicating with medical teams as well as for psychological treatment. Future research should examine how children's perceptions of their injury- and hospital-related experiences relate to later outcomes such as traumatic stress reactions.
There is little evidence on cognitions that are associated with emotional and behavioral problems in preschoolers during stressful events such as the COVID-19 pandemic. This article presents the ...initial development and validation of a caregiver-report instrument, the Preschooler Stressor-related Thoughts and Worries (PSTW) scale, developed during the COVID-19 pandemic. In 2020, caregivers from two countries reported on their child’s cognitions at baseline (T₀) and three months later (T₁; age 3–5 years; Australia: N = 559; United States: N = 346). Exploratory factor analysis (EFA) was conducted with the Australian sample at T₀ and confirmed with the U.S. sample at T₀. Exploratory factor analysis suggested a one-factor model including 10 items. Results of the confirmatory factor analysis failed to clearly support this structure (comparative fit index = .91, root mean square error of approximation = .11). Construct validity was supported by positive associations between PSTW scores and emotional and behavioral problems. Although the PSTW is a promising instrument to assess preschooler cognitions related to COVID-19, further investigation of its performance in other contexts (e.g., other countries, other stressful or traumatic events) is needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Source: journal abstract)
Objective: To examine the roles of psychologists in delivering pediatric palliative care (PPC) services, barriers and facilitators of psychologists' involvement in PPC, and strategies to improve ...psychology integration into PPC. Method: N = 131 PPC professionals (45% physicians, 26% psychologists, 12% advanced practice nurses, 17% other disciplines) employed at hospitals serving pediatric patients across the United States completed an online survey. Results: Most psychologists who provide PPC services are members of a primary team that delivers palliative care independently or in collaboration with a specialized PPC program. Psychologists provide various services within the purview of PPC, including interventions to relieve children's psychological and physical symptoms, support patient and family decision-making, and address grief and bereavement. Psychologists also commonly provide psychosocial support for health care providers and teach, supervise, and/or mentor trainees in PPC. Findings suggest a range of interrelated factors that influence integration of psychology in PPC, including funding, billing, time, training, institutional/departmental culture, quality of interdisciplinary collaborations, extent of psychosocial provider role differentiation, and perceptions of the value of psychology services. Strategies to improve integration included addressing funding, billing, and reimbursement challenges; expanding training and developing professional competencies for psychologists in PPC; optimizing communication and collaboration between psychologists and other PPC professionals; and conducting research on the value psychologists add to PPC teams. Conclusions: Pediatric psychologists provide a variety of important services to advance holistic care for children with life-limiting conditions and their families. Additional research examining the effectiveness of different models of psychology integration in PPC is warranted.
Implications for Impact StatementPediatric psychologists are not currently recognized as core members of interdisciplinary pediatric palliative care (PPC) teams, which aim to reduce physical, psychological, social, practical, and spiritual suffering for children with chronic illnesses. However, our findings suggest that pediatric psychologists provide important services to enhance the care of children with life-limiting conditions, including psychological assessment and treatment for patients and families, support for health care staff, supervision and mentorship of trainees, and skills in conducting research. This article outlines the roles and scope of services provided by psychologists within the purview of PPC and potential strategies for improving systematic inclusion of psychologists in PPC to advance holistic care for youth with serious illness and their families.
The purpose of this study was to describe child coping and parent coping assistance with cancer-related stressors during treatment. Fifteen children (age 6-12) with cancer and their parents (N = 17) ...completed semistructured interviews and self-report measures to assess coping and coping assistance. Results suggest families utilized a broad array of approach and avoidance strategies to manage cancer and its treatment. Quantitative and qualitative assessments provided complementary and unique contributions to understanding coping among children with cancer and their parents. Using a mixed methods approach to assess coping provides a richer understanding of families' experiences, which can better inform clinical practice.
Purpose
Nurses are at the forefront of children's postinjury recovery; this unique role provides an opportunity for nurses to recognize and screen for symptoms that may interfere with children's ...quality of life (QOL). As such, aims of the present investigation were to explore selected variables (e.g., posttraumatic stress symptoms PTSS, hope) that have the potential to impact QOL after pediatric injury, with a larger goal of contributing to recommendations for nursing practice to support children's full (physical and emotional) recovery during the peritrauma period following injury.
Design and methods
Sixty children (aged 7–13) completed measures of PTSS, hope, and QOL while receiving injury treatment.
Results
PTSS significantly predicted concurrent QOL, β = −0.42, p = 0.001. Exploratory results demonstrated that specific PTSS clusters (re‐experiencing
β = −0.39; p = 0.003), avoidance
β = −0.35; p = 0.009, arousal
β = −0.34; p = .012) all significantly predicted QOL. Specific PTSS were explored. Hope (overall, domains of pathways, general agency, goal setting) did not significantly predict concurrent QOL.
Practice implications
While this study is exploratory and more research is needed, current results suggest that nurses’ awareness of PTSS (including symptoms of re‐experiencing, avoidance, arousal) may help medical teams in identifying children that are at risk for impaired functional recovery (e.g., QOL) during the peritrauma period. Nurses may want to consider advocating for the integration of PTSS screeners into standard medical care. In addition, nurses have the opportunity to serve as key medical professionals in the delivery of trauma‐informed medical care (which aims to minimize further trauma or re‐traumatization). Nursing leadership may want to consider offering training in how nurses can identify and respond to children who have experienced an injury (such as trauma‐informed care).
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