Objective Although cross-sectional studies have demonstrated poor adherence to airway clearance therapy (ACT) for patients with cystic fibrosis (CF), no studies have identified longitudinal patterns of adherence. The objective was to characterize and identify predictors of ACT adherence trajectories for individuals with CF. Methods Secondary data analyses were conducted for a randomized clinical trial examining differences in three ACTs. Participants (n = 153; M = 14.3 years, 55% male, 86% Caucasian, baseline FEV₁% predicted: M = 86.7)/primary caregivers completed Daily Phone Diaries, an empirically supported adherence measure, every 4 months. Results Group-based trajectory modeling revealed the best-fitting solution was a three-group model: low-adherence (14%), medium-adherence (49%), and high-adherence (37%) groups. ACT type was the only significant predictor of adherence trajectories. Discussion Three trajectories of adherence to ACT for patients with CF were found. With the identification of trajectories, adherence interventions can be targeted for the subgroup at highest risk in order to prevent poor health outcomes.

Objectives To examine medication adherence trajectories posttransplantation and the association between adherence trajectories and self-reported internalizing symptoms in a pediatric population.  Methods Multilevel modeling was used to examine internalizing symptoms and longitudinal medication adherence, as assessed by electronic monitoring, among 55 children and adolescents who received liver or kidney transplantation.  Results Medication adherence generally declined over the study assessment window, and higher levels of anxiety were associated with higher and more stable patterns of medication adherence.  Conclusions Anxiety may be an important factor to consider when assessing and intervening with posttransplantation medication adherence. Future research should consider the potential reactivity effects of adherence monitoring, as well as individual and family behaviors associated with anxiety that may influence adherence.

Objectives To examine pump duration associations with adolescents’ metabolic control and whether parental involvement moderated this association. Methods This study used a cross-sectional sample of 10- to 14-year-olds with diabetes (N = 252, 53.6% female) and parents’ reported parental involvement; HbA1c was obtained from medical records. Half (50.8%) were on an insulin pump (continuous subcutaneous insulin infusion, CSII), with the remainder prescribed multiple daily injections (MDI). Results Adolescents on CSII displayed better HbA1c than those on MDI. A curvilinear association revealed that participants on CSII for <2 years showed a positive pump duration-HbA1c association, while those on CSII longer showed no association. Parental involvement interacted with pump duration to predict HbA1c. Pump duration was associated with poorer HbA1c only when parents were relatively uninvolved. Conclusions Within the limitations of a cross-sectional design, data suggest that adolescents on CSII have better HbA1c than those on MDI, but may experience a period of deterioration that can be offset by parental involvement.

Objectives To identify distinct patterns of glycemic control over early to middle adolescence, and to determine whether psychosocial variables predicted those patterns. Methods We used trajectory analysis to examine glycemic control over 5 years among adolescents with type 1 diabetes who were of age 12 on average at study start (n = 132). Well-being, relationships, and self-care behavior were assessed with in-person interviews. Blood glucose testing was determined from blood glucose meters, and missed clinic appointments and glycosolated hemoglobin were obtained from medical records. Results We identified two distinct clusters of individuals, a stable good glycemic control group and a poorer deteriorating glycemic control group. Individuals in the deteriorating control group were characterized by higher peer conflict, more negative diabetes emotions, fewer blood glucose tests, and more missed clinic appointments. Conclusion Psychosocial variables and behavioral markers of self-care may predict the course of glycemic control over early to middle adolescence.

Objectives To conduct a pilot study examining whether adding biofeedback-assisted relaxation training (BART) to medication treatment results in better clinical outcomes than medication treatment alone for children with functional dyspepsia (FD) associated with duodenal eosinophilia, a subgroup of children with recurrent abdominal pain. Methods Twenty children were randomly assigned to receive a standardized medication treatment or medication plus 10 sessions of BART. Children and parents completed psychosocial functioning and quality of life measures at baseline, posttreatment, and 6 months. Children rated pain daily via PDA. Physicians provided biweekly assessments of clinical improvement. Results Children receiving medication plus BART demonstrated better outcomes on pain intensity, duration of pain episodes, and clinical improvement than children receiving medication alone. Conclusions BART is a promising adjunctive treatment for pediatric FD associated with duodenal eosinophilia. Electronic daily diaries appear to be a useful approach to assessing changes in self-reported pain ratings in this population.

Objectives Examine the association between children’s distress and coping during venepuncture with parent’s and healthcare professional’s behavior in a sample from the UK.  Methods Fifty children aged 7–16 years accompanied by a carer were videotaped while having venepuncture. Verbalizations of children, parents, and healthcare professionals were coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Results Children’s distress was associated with child’s age, anxiety, and distress promoting behavior of adults (R² = .91). Children’s coping was associated with age, anxiety, and coping promoting behaviors of adults (R² = .57). Associations were stronger between healthcare professional’s behavior and child coping; and between parent’s behaviors and child distress. Empathizing, apologizing, and criticism were not frequently used by adults in this sample (<12%). Conclusion This study supports and extends previous research showing adult’s behavior is important in children’s distress and coping during needle procedures. Clinical implications and methodological issues are discussed.

Objective To establish feasibility and preliminary efficacy of "Coping with Pain in School" (CPS), an intervention to improve school functioning in adolescents with chronic pain and depressive symptoms. Methods Forty adolescents and parents participated in this uncontrolled trial. Participants completed measures of pain severity, depression, and school attendance at baseline and one month after participating in a manualized group intervention. Several other indicators of school functioning were explored. Results CPS was generally acceptable and satisfying to families and feasible to implement but participation was low. Post-treatment analyses suggest that pain, some dimensions of depression, and school attendance improved after treatment.  Conclusions CPS is feasible and holds promise in terms of its effects on pain and school attendance. Addressing enrollment challenges, refining the role of depression and its treatment, and further developing treatments with a school-functioning focus for adolescents with chronic pain are key areas for continued research.

Objective To study posttraumatic stress disorder (PTSD) in parents after unexpected pediatric intensive care unit (PICU) treatment of their child and to identify risk factors for its development. Method Parents completed PTSD questionnaires 3 and 9 months (N = 190) after PICU treatment. Risk factors included pretrauma data, medical data, social demographics and posttraumatic stress responses at 3 months. Results In total, 30.3% of parents met criteria for subclinical PTSD and 12.6% for clinical PTSD at 3 months. Clinical PTSD prevalence rates did not change over time. At 9 months, 10.5% of parents still met criteria for PTSD. Number of earlier stressful life events, earlier psychosocial care and posttraumatic stress responses at 3 months predicted persistent subclinical and clinical PTSD. Conclusions PICU admission is a stressful event associated with persistent parental PTSD. Assessment of risk factors can facilitate detection of persistent PTSD for early intervention.

Objectives We evaluated whether the phenotypic pattern of higher verbal than nonverbal IQ in children with spina bifida meningomyelocele (SBM) is consistent across subgroups differing in ethnicity and SES. We also explored the relation of cognitive and academic performance. Methods Non-Hispanic White (n = 153) and Hispanic (n = 80) children with SBM received the Stanford Binet Test of Intelligence-IV and achievement subtests of the Woodcock–Johnson. Parents completed questionnaires assessing the family environment [socioeconomic status (SES), resources, and educational opportunities]. Results Multivariate analysis revealed that Hispanic children with lower SES had lower verbal than nonverbal scores. Hispanic children with higher SES and non-Hispanic White children demonstrated the reverse pattern. Verbal and nonverbal IQ interacted to predict reading and math performance. Conclusions Lower SES is associated with lower verbal IQ in economically disadvantaged Hispanic children with SBM. Academic achievement is largely correlated with verbal IQ, but children with lower verbal IQ may partially compensate with higher nonverbal ability.

Objective The purpose of this study was to examine the psychometric properties of the Family Adaptability and Cohesion Evaluation Scales, version IV (FACES-IV) in families of children with cancer. Methods As part of a larger program of research, 147 mothers and 40 fathers from 162 families of children with cancer completed the FACES-IV. Parents and one healthy child from each family (77 girls; age M = 12.8, SD = 2.8) completed additional measures of family functioning and parenting. Results Internal consistencies above .70 were found for all subscales except one (Enmeshed, = .65). Intercorrelations of the subscales were similar to the validation sample but seemed inconsistent with the Circumplex Model on which the measure is based. Analyses raised questions regarding construct validity for the Enmeshed and Rigid subscales. Conclusions These preliminary findings suggest that more research is needed prior to widespread use of the FACES-IV in pediatric oncology populations.

Objective This study investigated motivation to attend appointments, self-efficacy, self-esteem, substance use, and emotional distress as predictors of optimal HIV appointment adherence in minority youth living with HIV. Methods Utilizing a prospective design, questionnaires were collected from 82 minority youth (mean age = 20.3) at baseline and appointment adherence was assessed over the subsequent 12-month period. Appointment adherence was dichotomized to reflect optimal (i.e., at least one appointment in each of the four quarters) versus suboptimal appointment adherence (i.e., no appointment in at least one of the four quarters). Results High levels of motivation to attend appointments, high levels of self-efficacy, and low levels of alcohol use were associated with optimal HIV appointment adherence. Conclusions Interventions promoting motivation and self-efficacy, while addressing alcohol use and awareness of appointment adherence may be promising in improving optimal HIV appointment adherence in minority youth.

Objective The heightened risk of cigarette smoking found among lesbian, gay, and bisexual (LGB) youths may be because smoking serves as a coping strategy used to adapt to the greater stress experienced by LGB youths. The current report examines whether smoking moderates the relation between stress and subsequent psychological distress, and whether alternative coping resources (i.e., social support) moderate the relation between smoking and subsequent distress. Method An ethnically diverse sample of 156 LGB youths was followed longitudinally for 1 year. Results Significant interactions demonstrated that smoking amplified the association between stress and subsequent anxious distress, depressive distress, and conduct problems. Both friend and family support buffered the association between smoking and subsequent distress. Conclusions Smoking has negative implications for the distress of LGB youths, especially those reporting high levels of stress or few supports. Interventions and supportive services for LGB youths should incorporate smoking cessation to maximally alleviate distress.

Objective To conduct a meta-analytic review of psychosocial adjustment of youth with inflammatory bowel disease (IBD). Methods Nineteen studies with a total of 1167 youth with IBD (M age = 14.33, 50% female) were included. Effect size (ES) estimates were calculated for anxiety symptoms & disorders, depressive symptoms & disorders, internalizing symptoms & disorders, externalizing symptoms, quality of life (QOL), social functioning, and self-esteem. Separate ESs were calculated for comparisons between IBD and youth with chronic illnesses versus healthy youth. Results Youth with IBD had higher rates of depressive disorders and internalizing disorders than youth with other chronic conditions. Youth with IBD had higher parent-reported internalizing symptoms, lower parent- and youth-reported QOL, and lower youth-reported social functioning compared to healthy youth. Conclusions Clinical attention to depressive disorders, QOL, and social functioning may be particularly salient in the context of pediatric IBD.

Objective Evaluate depressive symptoms in caregivers of children with type 1 diabetes (T1D) or cystic fibrosis (CF) and identify associated risk factors. Methods A total of 195 caregivers completed demographic, stress, and depressive symptoms questionnaires. Children’s health status was obtained from medical records. Results Approximately 33% of caregivers reported elevated symptoms of depression (i.e., exceeded clinical cutoff of 16 on the Center for Epidemiological Studies-Depression Scale). For caregivers of children with T1D, elevations were associated with less caregiver education, more family stress, older child age, and worse glycemic control. For caregivers of children with CF, more family stress and lack of employment outside of the home were associated with elevated depressive symptoms. Conclusions Many caregivers of children with T1D or CF experience depressive symptoms, although risk factors may differ in these two populations. Screening of caregiver depressive symptoms as part of routine clinic visits may provide opportunities for needed intervention.

Objective To examine possible relations between parents’ psychological stress and children’s saliva cortisol levels in connection with a mild stressor (drawing a blood sample). Method Parenting stress and serious life events at birth, age 1, age 2, age 5, and age 8 were assessed. Eighty-two paired saliva samples collected from their 8-year-old children just before and 30 min after blood was drawn were analyzed. Results Instead of increasing, cortisol levels significantly decreased. Repeated measures GLM indicated a significant relation between higher parenting stress at child age 1 and at age 8, and elevated cortisol levels. A t-test indicated that cortisol levels after the blood draw were significantly higher in children whose parents reported a serious life event at age 8. Conclusion Parenting stress could be a relevant factor for children’s adjustment of the HPA axis with long-term effects and leave children more vulnerable to experiences of stress.

Objective The current study examined the attributes of the reciprocated friends (RF) of a group of clinically referred obese children and the impact of these friendships on emotional well-being. Methods Classroom visits for 87 obese youth [body mass index (BMI) >95th percentile; 8- to 16-years old) were completed to obtain peer reports of social functioning, including reciprocated friendships, and to identify a demographically similar non-overweight comparison peer (CPO, n = 76). Subsequently, data regarding self-reported emotional well-being were collected from 84 obese children and 74 CPOs. Results Most obese children (68%) had at least one RF in their classroom. RFs were similar socially to CPOs and functioned more adaptively in the peer environment relative to obese children. Among obese youth, having at least one reciprocated friendship moderated the effect of sensitive-isolated behavior on loneliness. Conclusion Friendships may be a source of support for better psychosocial outcomes for obese youth.

Objective To examine the role of cortisol in posttraumatic stress symptomatology among mothers of children newly diagnosed with cancer. Methods Mothers (N = 27) completed standardized measures of posttraumatic stress symptoms and provided salivary cortisol samples at the time of their child’s cancer diagnosis and then monthly for 1 year. Results Random effects regression analyses of 351 person-by-time observations revealed that high levels of cortisol were associated with higher levels of posttraumatic stress symptoms (B = .12, p < .02). The mothers who exhibited higher cortisol levels at the time of their child’s diagnosis showed statistically significant declines in symptomatology from diagnosis to 12 months postdiagnosis (B = .97, p < .0001) compared to mothers who exhibited lower cortisol levels at diagnosis (B = .003, p < .05). Conclusions These findings offer some suggestions into possible neurobiological processes underlying posttraumatic stress symptoms and directions for future research and clinical intervention.

Objectives To test the efficacy of problem-solving skill training (PST) in improving health-related quality of life (HRQOL) of children with persistent asthma from predominantly lower socioeconomic status (SES) Spanish-speaking Hispanic families. Methods Randomized controlled trial comparing standard care waitlist (SC) control, home-visiting asthma education/care coordination (CC), and combined intervention (CC + PST) at baseline, after intervention, and 6-month follow-up. The primary outcome was parent proxy-report child HRQOL (PedsQL). Results Participants (n = 252) were 83.3% Hispanic and 56.3% monolingual Spanish speakers, and 72.6% of mothers had not graduated high school. We found a significant (P = 0.05) intervention effect for parent proxy-reported child generic (but not asthma-specific) HRQOL, with CC + PST superior to SC [83.8 vs 79.8; adjusted mean difference of 4.05 points (95% confidence interval 0.63–7.4], but no difference between the CC and SC groups. Conclusions In this sample of vulnerable families of children with persistent asthma, a CC + PST intervention was efficacious in improving children’s generic HRQOL.