Objectives Examine the contribution of sleep problems and indicators of inadequate sleep to psychopathology among children after accounting for shared risk and comorbid psychopathology. Methods Secondary analyses of cross-sectional data on 4- to 11-year-old (N = 1,550) children without chronic illness or developmental delay or disability. Parents provided information about sleep problems, indicators of inadequate sleep, symptoms of psychopathology, and risk factors for psychopathology. Teachers provided information about indicators of inadequate sleep and symptoms of psychopathology. Results Adjusting for risk factors and comorbid psychopathology, sleeping more than other children was related to parent-rated aggression. Nightmares and trouble sleeping were related to parent-rated anxious/depressed mood. Sleep problems were not related to attention problems. Being overtired was related to parent- and teacher-rated psychopathology. Conclusions Relations among sleep problems, indicators of inadequate sleep, and psychopathology are complex; accounting for potential confounding variables and considering sleep variables separately may clarify these relations.

Objective Cluster analyses allow health professionals to classify adolescents with chronic pain into subgroups, which might allow efficient tailoring of treatment. Given the nature of family relationships when a child has chronic pain, we aimed to evaluate whether an adolescent-disability-derived cluster formula would appropriately classify their parents via parenting stress, anxiety, and depression. Methods A patient-report data-derived cluster formula sorted 204 parents of adolescents with chronic pain into 4 groups. Parents completed measures of distress, anxiety, and depression. Results The 4-group solution generally sorted parents accurately, with parents of the least disabled adolescents functioning well and parents of the most disabled adolescents reporting clinically significant levels of stress, anxiety, and depression. Conclusions Findings suggest the patient-derived 4-group cluster solution might be an efficient method of distinguishing subgroups of parents with varying levels of stress, anxiety, and depression, which can be used to guide family-oriented treatment efforts.

Objective The aim of this article was to evaluate the effectiveness of an information provision web-based early intervention via a randomized controlled trial for children and their parents following pediatric unintentional injury. Method Participants were randomly assigned to an intervention (n = 29) or a control group (n = 27) following baseline measurements. Further assessment was taken at 4–6 weeks and 6 months post-trauma event. Results Analyses revealed that children within the intervention group reported improved anxiety, in comparison to a worsening of symptoms for children in the control group. Furthermore, children who had higher baseline trauma scores reported the intervention to be helpful. Conclusions The intervention showed promising results in its ability to aid child recovery.

Objective To evaluate the psychometric properties of the Family Impact Module (FIM), a parent self-report measure of health-related quality of life (HRQOL) and family functioning, among parents of youth with chronic pain. Methods Parents (N = 458) completed the FIM (Total Impact, HRQOL, and Family Functioning scales); parents and youth (N = 332) completed measures of pain catastrophizing, pediatric quality of life, and emotional/behavioral functioning. Results The FIM demonstrated strong internal consistency and item-total correlations. All FIM scales were positively associated with pain catastrophizing, functional disability, and emotional/behavioral problems; and inversely related to pediatric quality of life. Mothers reported significantly worse HRQOL than fathers. Mothers and fathers did not differ on reports of Family Functioning. HRQOL and Family Functioning did not differ as a function of pain diagnosis. Conclusion The FIM appears to be a suitable measure of parent self-reported HRQOL and family functioning in pediatric chronic pain.

Objectives The purpose of this pilot study was to determine the association of observed parenting behaviors with adjustment in adolescents with type 1 diabetes (T1D) and their mothers. Methods Adolescents with T1D (n = 30) and their mothers provided data on psychosocial adjustment and engaged in a discussion task about diabetes stress, which was coded for parenting behavior. Clinical data (i.e., HbA1c) was obtained from adolescents’ medical records. Results Mothers’ symptoms of anxiety and depression were related to lower levels of child-centered parenting. Higher levels of observed child-centered parenting and positive reinforcement and lower levels of maternal hostility and parental influence were related to better psychosocial adjustment in adolescents (i.e., fewer depressive symptoms, better quality of life) and better metabolic control. Conclusions Results support the use of observational data in this population and provide estimates of effect sizes between parenting variables, maternal and adolescent psychosocial adjustment, and metabolic control.

Objective To examine whether children's experience of pain intensity and anxiety, and adult behaviors during venepuncture, were related to children's memories of the procedure. Methods Participants were 48 children (24 males, 24 females) between the ages of 5 and 10 years who underwent venepuncture. The venepunctures were videotaped and adult behaviors were coded. Children self-reported their pain intensity and anxiety immediately and 2 weeks following venepuncture and answered contextual questions at follow-up. Results Children who initially reported higher levels of pain tended to over-estimate their anxiety at follow-up, whereas children who reported lower levels of pain accurately- or under-estimated their anxiety. Staff coping-promoting behaviors predicted the accuracy of children's contextual memories. Staff and parent behaviors did not predict children's recalled pain intensity and anxiety. Conclusions Results indicate that children's direct experience of pain intensity and staff behaviors during venepuncture are related to their memories. These data highlight the importance of effective pain management during medical procedures.

Objective Based on social ecological theory, this study was designed to examine the unique relationships between multi-level ecological factors and psychological symptoms in young adults with spina bifida (SB). Method A sample of 61 individuals with SB, 18–25 years of age, completed standardized self-report measures of attitude toward SB, satisfaction with family functioning, Chronic Care Model (CCM) services, and depressive and anxiety symptoms. A chart review yielded SB clinical data. Results High rates of depressive and anxiety symptoms were found. Hierarchical regression analysis identified the proximal individual (attitude toward SB) and family (satisfaction with family functioning) factors as more strongly related to depressive symptoms than the distal healthcare system factor (CCM services). Self-reported pain was the only ecological factor associated with anxiety symptoms. Conclusions Study findings provide a potential foundation for multi-factor screening of young adults with SB at risk for psychological symptoms.

Objective This study examined the psychosocial predictors of poor sleep quality in parents caring for children with developmental disabilities. Methods Sixty-seven parents of children with developmental disabilities and 42 parents of typically developing children completed the Pittsburgh Sleep Quality Index, and measures of parental stress, child problem behaviors, and social support. Results Parents of children with developmental disabilities reported poorer sleep quality. Further, the majority of these parents met the established ‘poor sleepers’ criterion. The strongest predictor of poor sleep quality was parental stress. This finding withstood adjustment for a number of potential confounders. Conclusions Parental stress is associated with poor sleep quality in parents of children with developmental disabilities. The monitoring and management of sleep issues in these parental caregivers should be a priority for health professionals.

Objective To assess whether family involvement and acculturation were related to adherence and glycemic control among Hispanic youth with type 1 diabetes (T1D). Methods Hispanic youth with T1D (n = 111; M age = 13.33; 53% female) and parents completed questionnaires that assessed diabetes-related family involvement (distribution of responsibility for diabetes, family support for diabetes), acculturation (linguistic acculturation, generational status), and adherence. HbA1c levels indexed glycemic control. Results Better adherence was associated with less adolescent independent responsibility, more family support for diabetes, and more recent immigration (fewer generations of the family living in US). Family support mediated the relationship between responsibility and adherence. Better glycemic control was associated with higher levels of parental education and adherence. Conclusions Family support for diabetes is important for adherence among Hispanic youth with T1D. Research should examine aspects of recent immigration that contribute to better adherence and the impact of supportive interventions on diabetes care.

Objective To examine prospective relationships between caregiver's depressive symptoms and child asthma morbidity among inner-city African American families. Methods Phone surveys were conducted 6 months apart with 262 African American mothers of children with asthma. Cross-lagged structural path analysis was used for data analyses. Results Using goodness-of-fit indices, the final model for asthma symptoms had a good fit to the data. Time 1 (T1) maternal depressive symptoms predicted T2 child asthma symptoms (β = .16, p < .01); however, T1 asthma symptoms did not predict T2 maternal depressive symptoms (β = .03, non-significant). In contrast, in the final model for emergency department (ED) visits there was no predictive association between maternal depressive symptoms and ED visits. Conclusion Maternal depressive symptoms may have a detrimental effect on child asthma morbidity among inner-city African American families, rather than vice versa. Ameliorating maternal depressive symptoms may result in better asthma outcomes for inner-city children.

Objective This prospective longitudinal study examines the course of posttraumatic stress symptoms (PTSS) in mothers of children with burns between 1 and 11 years after the burn event and the role of burn severity and feelings of guilt on this course. Method Self-reported PTSS of 48 mothers were measured with the Impact of Event Scale. Guilt feelings were assessed during an in-depth interview 2 years after the burn event. Eleven years after the burn event, mothers marked their child's scars at the present time on a drawing. Results Over a period of 10 years, maternal PTSS decreased. Multiple regression analysis showed that the interaction between guilt and burn severity predicted the course of PTSS. Conclusions Although PTSS substantially decreases through the years, a subset of mothers, in particular mothers who feel guilty about the burn event and whose children have more extensive permanent scarring seem at risk for longer term PTSS.

Objective The behavioral ratings of preschoolers who sustained traumatic brain injury (TBI) prior to the age of 2 years and a typically developing group were compared; predictors of behavioral functioning were examined. Methods Eighty-two 3-year-olds comprised mild TBI (n = 31), moderate/severe TBI (n = 20), and typically developing (n = 31) groups, with Child Behavior Checklist (CBCL) as the primary outcome measure. Results Groups differed on the CBCL Withdrawal Scale. No differences emerged in the proportion of children demonstrating clinical elevations, with average mean scores for each group. Exploratory analyses yielded no differences between inflicted, non-inflicted, and typical groups. Glasgow Coma Scale and Self-Report Family Inventory Leadership predicted Externalizing Problems; developmental level predicted Internalizing Problems. Conclusions After early TBI, preschoolers did not differ from one another or a matched comparison group in behavioral ratings; however, it may be premature to infer that preschoolers do not evidence behavioral dysfunction after early TBI.

Objective To present a case study using multisystemic therapy (MST), an intensive family focused psychotherapy. For the clinical trial from which this case was drawn, MST was adapted to address multiple human immunodeficiency virus (HIV) transmission risk behaviors in HIV-infected youth. Targeted behaviors included medication nonadherence, risky sexual behaviors, and substance use. Method One young woman's transmission risk behaviors are described, followed by a description of the MST procedures used to identify and treat the primary drivers of these risk behaviors. Outcome measures were self-report, urine screens, and blood draws. Results At discharge, the young woman showed significant improvements in medication adherence and related health status (e.g., reduced HIV viral load), healthier sexual behaviors, and reduced substance use. Importantly, neither her boyfriend nor her newborn tested positive for HIV. Conclusions Findings from this case study suggest that MST has the potential to reduce transmission risk behaviors among teens with HIV.

Objective To examine if maltreatment predicted increased risk of hospital-based treatment prior to age 18 years for asthma, cardio-respiratory, and non-sexually transmitted infectious disease in a sample of low-income children. Methods This study used administrative data from multiple systems to follow children for 12–18 years (N = 6,282). Cox regression was used to explore the risk of first hospital treatment by disease category. Negative binomial regression was used to explore the relationship between recurrent maltreatment and total hospital care episodes. Results Controlling for individual, family, and community factors, children with maltreatment reports had a 74–100% higher risk of hospital treatment. Recurrent reports predicted a higher count of hospital care episodes. Conclusions The negative health impact of maltreatment prior to adulthood supports the need for early prevention and intervention to prevent initial and recurrent child abuse and improve capacity to meet healthcare needs of maltreated children.

Objective To test the measurement equivalence of the Youth Life Orientation Test (YLOT) in children with cancer (N = 199) and healthy controls (N = 108), and to examine optimism and pessimism as predictors of children's health-related quality of life (HRQL). Methods Confirmatory factor analysis (CFA) was conducted to establish the two factor structure of the YLOT and to test for metric invariance. Results A two-factor structure for the YLOT was confirmed and found to be stable across our study groups. There were no differences in mean levels of optimism and pessimism between cancer patients and controls after controlling for race/ethnicity. Higher optimism was associated with lower self-reports of pain and better emotional/behavioral functioning, whereas pessimism was related to poorer mental health and general behavior, and greater impact on the family. Conclusions Optimism and pessimism appear to be differentially related to certain aspects of children's HRQL, and should be investigated separately in relation to these outcomes.