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ABSTRACT: OBJECTIVES: We compared the degree of psychosocial impairment in patients seen in the emergency department (ED) for acute complaints with that of patients presenting with chronic complaints using the Youth Pediatric Symptom Checklist (PSC-Y). Our hypothesis was that patients with multiple visits for chronic complaints (>3 health care visits for the chief complaint during the previous 12 months) would be more likely than patients with acute complaints to test positive for psychosocial issues. METHODS: The PSC-Y was administered to patients aged 8 to 18 years presenting to a pediatric ED for nonpsychiatric complaints. We compared proportions of patients testing positive for psychosocial impairment on the PSC-Y or any of its subscales. RESULTS: In the 442 patients enrolled, 25% endorsed chronic symptoms. There was a significant difference in the proportion of patients scoring positive for psychosocial impairment between the acute and chronic group (13.8% vs 18.1%, P = 0.002) as well as in the proportion of patients testing positive for attentional issues (6.4% vs 13.9%, P = 0.02). Each subscale was analyzed independently, and there were no statistically significant intergroup differences in internalizing symptoms (anxiety, depression) or externalizing symptoms (conduct issues). CONCLUSIONS: Patients with recurrent presentations for the same complaint had significantly higher rates of overall psychosocial impairment. Regardless of complaint acuity, impairment rates were notable, with 20% of patients reporting internalizing symptoms, such as anxiety and depression. Psychosocial issues should be considered in all pediatric ED patients but particularly those with greater than 3 health care visits for the same presenting complaint.
Pediatric emergency care 11/2012; · 0.92 Impact Factor
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ABSTRACT: The objective of this study was to examine the level of agreement between child- and caregiver-reports of the child’s psychosocial
problems presenting to a Pediatric Emergency Department (PED) using a validated screening tool. This was an anonymous, prospective,
cross-sectional, multi-informant (child and caregiver) study assessing cognitive, emotional, and behavioral problems and physical
complaints in children and adolescents presenting to a PED. Three-hundred and fifty-eight children and adolescents (8–18years
old) and their caregivers participated. Children completed the Youth-Pediatric Symptom Checklist (PSC-Y), while their caregivers
completed the Pediatric Symptom Checklist–35 (PSC-35) to measure psychosocial impairment. The child’s physical complaints
(e.g., chief complaint, chronicity, other medical problems, medications) and demographic information were assessed using an
investigator-developed patient background questionnaire completed by the caregivers. Physical complaints (e.g., chief complaint,
chronicity, other medical problems, medications) were assessed using an investigator-developed patient background questionnaire.
Agreement between child- and caregiver- reports was analyzed using Cohen’s kappa coefficient. Differences between child and
caregiver-reported scores were determined by t-tests. Poor to moderate agreement was found between child- and caregiver-reports of attention problems (κ =.355), externalizing
problems (κ=.340), internalizing problems (κ=.065), and total PSC score (κ=.410). Both children and caregivers should
complete the psychosocial screener to maximize the accuracy of assessment and the identification of impairment.
KeywordsPediatric–Emergency Department–Concordance–Psychosocial impairment
Journal of Child and Family Studies 04/2012; 20(4):473-477. · 1.12 Impact Factor
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ABSTRACT: To further understand the influence of psychological variables on pain and functioning in children with chronic pain by examining the relations between pain, anxiety sensitivity (AS), somatization, and health-related quality of life (HRQOL), and whether they vary as a function of age and gender.
66 children (8-12 years) and adolescents (13-18 years) with chronic pain completed measures assessing pain intensity, AS (childhood anxiety sensitivity index), somatization (child somatization inventory), and HRQOL (pediatric quality of life inventory 4.0).
Somatization was significantly related to higher pain intensity. Somatization significantly predicted HRQOL over and above pain. AS was a significant predictor of impaired HRQOL for children and females in the sample, but not for adolescents or males.
Somatization and AS may be better predictors of HRQOL impairment than pain intensity in children with chronic pain. This may differ as a function of age and gender.
Journal of Pediatric Psychology 04/2012; 37(7):808-16. · 2.91 Impact Factor
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ABSTRACT: Background
Children with siblings coping with chronic illness experience stresses and disruptions in daily life as families work together to care for the affected child. Research suggests that children and adolescents with sickle cell disease (SCD) may be at risk for adjustment problems, impaired psychosocial functioning, and reduced quality of life. These potential stressors affect the child with SCD as well as their caregivers and other family members. This study examined the role of family functioning on the psychosocial functioning of healthy siblings of children with SCD.ProcedureParticipants were 65 healthy African–American siblings of children with SCD with a mean age of 11.19 years (range: 7–16) and their primary caregiver. Caregivers completed questionnaires assessing family functioning and child adjustment including demographic surveys, the Family Relations Scale (FRS), and the Child Behavior Checklist (CBCL).ResultsIncreased number of emergency room visits (β = −0.28, P < 0.05) predicted poor psychosocial adjustment in siblings. Family functioning mediated this effect (β = 0.27; P < 0.05). High levels of family expressiveness (total score, r = −0.34; P < 0.01), support (total score, r = −0.54; P = 0.001), and low levels of family conflict (total score, r = 0.41; P < 0.001) were associated with improved adjustment among healthy siblings of children with SCD.Conclusions
Awareness of the possible negative psychosocial outcomes of living with a sister or a brother with SCD is important for clinicians. In particular, interventions that focus on family expressiveness, support, and conflict are indicated for this population. Pediatr Blood Cancer 2011; 57: 1055–1061. © 2011 Wiley-Liss, Inc.
Pediatric Blood & Cancer 11/2011; 57(6):1055 - 1061. · 1.89 Impact Factor
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Journal of critical care 07/2011; 27(1):95-6. · 2.13 Impact Factor
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ABSTRACT: Hyperemesis gravidarum (HG) can be accompanied by severe physical and emotional distress. Most studies have focused on the physical and psychological stress associated with this condition during the affected pregnancy. This study explores posttraumatic stress symptoms (PTSS) and negative life outcomes following HG pregnancies.
A total of 610 women (HG = 377 and control = 233) were recruited and completed an online survey. χ-square analyses were used to compare the HG and control groups on various life outcome variables.
Eighteen percent of women with HG reported full criteria PTSS (n = 68). Negative life outcomes regarding financial and marital status, career, as well as psychological and physical well-being differed significantly for the HG groups compared to the control group (0.001 < p < 0.05).
PTSS is common following HG pregnancies and is associated with negative life outcomes including inability to breastfeed, marital problems, financial problems, and inability of self care.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 06/2011; 24(11):1307-11. · 1.36 Impact Factor
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ABSTRACT: To evaluate posttraumatic stress disorder in children who have been admitted to the pediatric intensive care unit and their families.
Studies were identified through PubMed, MEDLINE, and Ovid.
All descriptive, observational, and controlled studies with a focus on posttraumatic stress disorder and the pediatric intensive care unit were included.
Posttraumatic stress disorder rates in children following admission to the pediatric intensive care unit were between 5% and 28%, while rates of posttraumatic stress disorder symptoms were significantly higher, 35% to 62%. There have been inconsistencies noted across risk factors. Objective and subjective measurements of disease severity were intermittently positively associated with development of posttraumatic stress disorder. There was a positive relationship identified between the child's symptoms of posttraumatic stress disorder and their parents' symptoms.The biological mechanisms associated with the development of posttraumatic stress disorder in children admitted to the pediatric intensive care unit have yet to be explored. Studies in children following burn or other unintentional injury demonstrate potential relationships between adrenergic hormone levels and a diagnosis of posttraumatic stress disorder. Likewise genetic studies suggest the importance of the adrenergic system in this pathway.The rates of posttraumatic stress disorder in parents following their child's admission to the pediatric intensive care unit ranged between 10.5% and 21%, with symptom rates approaching 84%. It has been suggested that mothers are at increased risk for the development of posttraumatic stress disorder compared to fathers. Objective and subjective measures of disease severity yielded mixed findings with regard to the development of posttraumatic stress disorder. Protective parental factors may include education or the opportunity to discuss the parents' feelings during the admission.
Following admission to the pediatric intensive care unit, both children and their parents have high rates of trauma exposure, both personally and secondary exposure via other children and their families, and subsequently are reporting significant rates of posttraumatic stress disorder. To effectively treat our patients, we must recognize the signs of posttraumatic stress disorder and strive to mitigate the negative effects.
Pediatric Critical Care Medicine 04/2011; 13(3):338-47. · 3.13 Impact Factor
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ABSTRACT: Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. While the exact neurobiological mechanisms behind VR's action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance.
Pain management. 03/2011; 1(2):147-157.
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ABSTRACT: Children with siblings coping with chronic illness experience stresses and disruptions in daily life as families work together to care for the affected child. Research suggests that children and adolescents with sickle cell disease (SCD) may be at risk for adjustment problems, impaired psychosocial functioning, and reduced quality of life. These potential stressors affect the child with SCD as well as their caregivers and other family members. This study examined the role of family functioning on the psychosocial functioning of healthy siblings of children with SCD.
Participants were 65 healthy African-American siblings of children with SCD with a mean age of 11.19 years (range: 7-16) and their primary caregiver. Caregivers completed questionnaires assessing family functioning and child adjustment including demographic surveys, the Family Relations Scale (FRS), and the Child Behavior Checklist (CBCL).
Increased number of emergency room visits (β = -0.28, P < 0.05) predicted poor psychosocial adjustment in siblings. Family functioning mediated this effect (β = 0.27; P < 0.05). High levels of family expressiveness (total score, r = -0.34; P < 0.01), support (total score, r = -0.54; P = 0.001), and low levels of family conflict (total score, r = 0.41; P < 0.001) were associated with improved adjustment among healthy siblings of children with SCD.
Awareness of the possible negative psychosocial outcomes of living with a sister or a brother with SCD is important for clinicians. In particular, interventions that focus on family expressiveness, support, and conflict are indicated for this population.
Pediatric Blood & Cancer 02/2011; 57(6):1055-61. · 1.89 Impact Factor
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ABSTRACT: The misuse of sham controls in examining the efficacy or effectiveness of Complementary and Alternative Medicine has created numerous problems. The theoretical justification for incorporating a sham is questionable. The sham does not improve our control of bias and leads to relativistic data that, in most instances, has no appropriate interpretation with regards to treatment efficacy. Even the concept of a sham or placebo control in an efficacy trial is inherently paradoxical. Therefore, it is prudent to re-examine how we view sham controls in the context of medical research. Extreme caution should be used in giving weight to any sham-controlled study claiming to establish efficacy or safety.
Evidence-based Complementary and Alternative Medicine 01/2011; 2011:842767. · 4.77 Impact Factor
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ABSTRACT: 'March of the Living' is a 2-week excursion to Poland and Israel for high school students to learn and experience sites of Holocaust destruction.
This study looked at the effect of their experience on spirituality and health. The sample consisted of 134 Jewish students, ages 16-19 years. Students were assessed initially (before MOTL=time 1) by completing a background survey (i.e., demographics, "Jewishness," and Holocaust related information), a World Health Organization, Quality of Life-Spirituality, Religion, and Personal beliefs field-test instrument, and the Child Somatization Inventory. Surveys were repeated end-Poland (time 2) and again (after MOTL=time 3) approximately 3-4 months after the trip.
Most facets of spirituality significantly increased between time 1 and time 2, and varied from time 2 to time 3, while strength and hope remained elevated. Faith increased from time 1 to time 2 and was maintained at time 3. Fear of dying rose at time 2, decreasing significantly at time 3. A positive correlation between spirituality and "Jewishness" was found.
The Israel journal of psychiatry and related sciences 01/2011; 48(3):186-94. · 0.68 Impact Factor
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ABSTRACT: To determine the relationship between stress indicators and state anxiety among pediatric emergency department (ED) patients, as a background to develop appropriate psychoeducational and behavioral interventions.
Patients with nonchronic conditions aged 10 to 18 years completed questionnaires assessing demographics; (8) life stressors (LSs), such as death in family and marital separation/divorce; (10) anticipatory stressors (ASs) such as fear of needles, blood, or undressing; and the State Trait Anxiety Inventory for Children (a 20-item validated tool).
One hundred patients completed the study: the mean age was 13.3 years; 56% were female; and 90% were Latino patients. Notable life stressors (mean, 1.83) included: change in school location (24%), change in school performance (29%), death in family (33%), and marital separation/divorce (48%). Common AS (mean, 4.76) included worry about shots (33%), strangers (41%), talking about personal problems (44%), separation from parents (51%), undressing (56%), hospitalization (57%), and pain (73%). Significant correlations were found between age and state anxiety (r, -0.21; P < 0.05), age and AS (r, -0.38; P < 0.001), and AS and state anxiety (r, 0.20; P < 0.05). Patients with clinical state anxiety (36%) were more likely to be in the ED with a complaint of pain and/or trauma, had significantly more AS (t, 2.1; P < 0.05), and worry about parental separation (χ, 5.5; P < 0.05) and blood tests (χ, 4.9; P < 0.05) than patients with subclinical state anxiety.
The ED experience produces fear/anxiety, particularly in younger patients with a chief complaint of pain and/or trauma. Findings may lead to the development of psychoeducational and behavioral interventions that focus on anxiety reduction.
Pediatric emergency care 12/2010; 26(12):897-901. · 0.92 Impact Factor
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ABSTRACT: Chronic pain and fatigue are common physical complaints among children and adolescents. Both symptoms can interfere considerably with daily life by affecting sleep and eating habits, engagement in physical and social activities, and school participation. The aim of this study was to examine the potential mediational role of fatigue in the relationship between pain and children's school functioning and overall health-related quality of life (HRQOL).
Children seeking outpatient pain management services at two urban children's hospitals were recruited for this study. The combined sample includes 80 children and adolescents between the ages of 8 and 18 years (M=13.89, SD=2.57), 72.5% female, and their caregivers. The Pediatric Quality of Life Inventory (PedsQL 4.0) was used to assess HRQOL and the related PedsQL Multidimensional Fatigue Scale provided a comprehensive measure of fatigue.
On the basis of Preacher and Hayes' mediation model (2004), fatigue functioned as a mediator between pain and overall HRQOL on the basis of both self and caregiver proxy reports. Fatigue functioned as a mediator between pain and school functioning on the basis of the caregiver proxy report only. Additionally, moderate relationships were found between self and caregiver proxy reports of HRQOL and fatigue, although children self-reported less fatigue, better school functioning, and greater quality of life than did their caregivers.
Findings demonstrated that fatigue is a significant problem for many youth with chronic pain and may be an important target for clinical intervention.
The Clinical journal of pain 07/2009; 25(5):407-12. · 3.01 Impact Factor
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ABSTRACT: Virtual reality (VR) is a relatively new technology that enables individuals to immerse themselves in a virtual world. This multisensory technology has been used in a variety of fields, and most recently has been applied clinically as a method of distraction for pain management during medical procedures. Investigators have posited that VR creates a nonpharmacologic form of analgesia by changing the activity of the body's intricate pain modulation system. However, the efficacy of VR has not been proven and the exact mechanisms behind VR's action remain unknown. This article presents a comprehensive review of the literature to date exploring the clinical and experimental applications of VR for pain control. The review details specific research methodologies and popular virtual environments. Limitations of the research, recommendations for improvement of future studies, and clinical experiences with VR are also discussed.
Current Pain and Headache Reports 05/2009; 13(2):100-9. · 1.66 Impact Factor
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ABSTRACT: Sickle cell disease (SCD) is associated with increased risk of stroke and cognitive impairment. This study describes a retrospective review of 65 patients who underwent routine neuropsychological testing and MRI during treatment at a comprehensive sickle cell center. It was hypothesized that (1) children with no evidence of CVA would perform lower than expected on cognitive tasks compared to population-based normative data, (2) children with strokes and children with silent infarcts would perform lower on cognitive tasks and motor skills as compared to patients with no evidence of CVA, and (3) children with evidence of silent infarcts would perform better than children with known overt strokes. This final hypothesis has not been studied previously, as children with known overt stroke and silent infarct were grouped together. Sixty-five children with SCD who were sent for routine neuropsychological testing and brain MRI were identified via retrospective chart review. Patients had been administered neuropsychological tests to assess cognitive, executive and motor function. Brain MRI was obtained from each patient and was analyzed for evidence of cerebrovascular accident (CVA). Based on MRI analysis, 27% of patients with SCD had experienced a stroke and 13% a silent infarct. The majority (59%) of patients diagnosed with stroke or infarct sustained cortical damage to the frontal lobe. Patients with SCD and no evidence of CVA functioned normally on tests of cognitive ability and achievement, but patients with CVA displayed impairments in cognitive function and comparatively lower scores on verbal and performance scales. Neuropsychological testing can identify impairments in patients with SCD with no known cerebrovascular accident. Investigations of neurocognitive functioning will help characterize patterns of deficits and can inform the ability to implement comprehensive care strategies for patients with SCD and cognitive impairment.
Pediatric Hematology and Oncology 07/2008; 25(5):409-21. · 0.89 Impact Factor
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ABSTRACT: This article reviews current research on acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) resulting from pediatric simple (i.e., single, unpredictable, and unintentional) physical injury and how pain may act as both a trigger and a coexisting symptom. Although several studies have explored predictors of ASD and PTSD, as well as the relationship between these conditions in adults, there is less research on ASD and PTSD in children and adolescents. This review highlights the importance of early detection of pain and acute stress symptoms resulting from pediatric unintentional physical injury in the hopes of preventing long-term negative outcomes, such as the potential development of PTSD and associated academic, social, and psychological problems.
Journal of Pediatric Nursing 05/2008; 23(2):81-91.
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ABSTRACT: Practiced in China for more than 2000 years, acupuncture has recently gained increased attention in the United States as an alternative treatment approach for a variety of medical conditions. Despite its growing prevalence and anecdotal reports of success among pediatric populations, few empirically based studies have assessed the efficacy of acupuncture for children and adolescents. This article presents a review of the current literature, including a systematic appraisal of the methodological value of each study and a discussion of potential benefits and adverse effects of acupuncture. While acupuncture holds great promise as a treatment modality for diverse pediatric conditions, a significant amount of additional research is necessary to establish an empirical basis for the incorporation of acupuncture into standard care.
Evidence-based Complementary and Alternative Medicine 02/2008; 6(4):429-39. · 4.77 Impact Factor
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ABSTRACT: Pediatric massage therapy (MT), similar to its younger counterpart infant massage, has a limited number of rigorous studies supporting its clinical application and associated effects. However, clinicians and researchers have been intrigued by the potential benefits of pediatric MT for improving psychological and physiologic states in children who have various health conditions. This article provides a broad overview of pediatric MT, including proven and promising effects of MT across disease-specific clinical applications, contraindications, safety, context and availability of services, and future directions. Computerized databases were searched for relevant studies, including prior reviews, primary case studies, and randomized controlled trials of infant and pediatric MT. Current findings provide varying levels of evidence for the benefits of pediatric MT in children who have diverse medical conditions; however, anxiety reduction has shown the strongest effect. Future studies should use rigorous study design and methodology, with long-term follow-up, for examining the longitudinal effects of pediatric MT.
Pediatric Clinics of North America 01/2008; 54(6):1025-41; xii-xiii. · 2.24 Impact Factor
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ABSTRACT: To provide a review of the evidence base of family measures relevant to pediatric psychology.
Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: "Well-established", "Approaching well-established", or "Promising."
Nineteen measures met "well-established" criteria and the remaining ten were "approaching well-established." "Well-established" measures were documented for each of the broad assessment categories named above.
Many measures deemed "well-established" in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures.
Journal of Pediatric Psychology 10/2007; 33(9):1046-61; discussion 1062-4. · 2.91 Impact Factor
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ABSTRACT: During the past decade, virtual reality (VR) has gained recognition as a means of attenuating pain during medical procedures. However, while investigators have examined the effects of virtual environments on level of distraction, subjective pain intensity, and brain activity, there have been only a handful of investigations into the neurobiological mechanisms associated with VR's efficacy. In an effort to explain how VR may alter pain perception and produce analgesia, as well as to guide the development of novel and improved VR pain treatments, this review aims to link the wealth of empirical data examining the neurobiology of pain to the growing field of VR. This review is separated into three main sections: (a) a brief overview of the current literature on the use of VR for the treatment of pain; (b) a review of the basic neurobiology of how pain is detected, processed, and controlled by the brain; and (c) an exploration into how current VR pain treatments may impact the pain system to produce analgesia. In addition, the future of VR for pain treatment is discussed, including how current treatments might be improved and novel ways to use VR to treat pain might be developed. Speculation on future VR interventions is based on our current understanding of how the brain processes pain and how VR appears to alter this process and produce analgesia.
CyberPsychology & Behavior 09/2007; 10(4):536-44. · 2.71 Impact Factor
