The association of maternal food intake and infants' and toddlers' food intake

BACKGROUND

Young children's first experiences with food may influence development of food preferences and lifelong eating habits. However, little is known about what factors are associated with the development of eating behaviours in infants and toddlers. Studies with older children and adolescents suggest that parental food intake is associated with children's food intake. The purpose of the present paper is to determine whether this association starts even earlier during infancy and toddlerhood.

METHODS

A convenience sample of n= 98 primarily African American mothers of children 6-18 months old completed questionnaires, including questions on their own and their young child's food intake. Mothers completed questions while waiting to be seen by their child's primary care provider.

RESULTS

Per maternal report, children consumed fruit 2.45 (1.79) times, vegetables 1.63 (1.51) times and snack foods 2.22 (2.49) times each day. Infants' and toddlers' fruit (r= 0.54, P < 0.001), vegetable (r= 0.42, P < 0.001) and snack food (r= 0.37, P < 0.001) intake were significantly associated with maternal intake of each of these foods, respectively. These significant associations remained even after controlling for additional study variables.

CONCLUSION

Even at very young ages, maternal food intake is an important correlate of children's food intake. Taken together with findings documenting significant snack food consumption in this age group, findings suggest that development of prevention and intervention programmes to enhance healthy eating behaviours need to start very early, perhaps just prior to children being introduced to complementary foods.

A randomized, controlled evaluation of early intervention: the Born to Learn curriculum

BACKGROUND

This study addressed the need for studies of the efficacy of the Born to Learn (BTL) curriculum.

METHODS

Based on random assignment, 227 families of infants received the BTL curriculum conducted in monthly home visits, and 237 families received general child development education only.

RESULTS

The BTL curriculum resulted in higher mastery motivation (task competence) at 36 months (P < 0.05) and greater effects for children from low (P < 0.01) versus high socio-economic status on mastery motivation and cognitive development at 24 months. No effects were found on a wide range of other developmental outcomes.

CONCLUSION

Future studies should document the BTL curriculum effectiveness in diverse settings and samples.

The relationship of maternal and child HIV infection to security of attachment among Ugandan infants

This study was designed to examine the relationship of maternal and child human immunodeficiency virus (HIV) infection to the security of attachment of Ugandan infants. The attachment patterns of two groups of Ugandan mother-infant pairs: 35 HIV-positive mothers and their infants and 25 HIV-negative mothers and their infants were compared. We tested the hypothesis that infants of HIV-positive mothers would demonstrate less secure attachment as measured by the Waters Attachment Q-set than infants of HIV-negative mothers. No differences were found in the security of attachment of infants of HIV-positive versus HIV-negative mothers. Infants of HIV-positive mothers with Acquired Immunodeficiency Syndrome (AIDS) were less securely attached than infants of mothers without AIDS. These findings underscore the relationship of infant security of attachment to maternal HIV infection in the presence of AIDS-related symptoms but not to asymptomatic maternal HIV infection.

Steps toward a clinically relevant science of interventions in pediatric settings: introduction to the special issue

OBJECTIVE

To describe methods and strategies to advance the science of interventions in pediatric psychology.

METHODS

We consider the advantages of various strategies to develop and extend the applications of intervention research in pediatric practice settings.

RESULTS

Strategies are needed to enhance application of empirically supported interventions to pediatric settings, including testing the generalizability of empirically supported interventions in clinical samples, developing interventions based on clinical experience and tested in controlled clinical trials, designing program evaluations in the context of practice settings, and conducting case studies and series. Critical next steps in intervention research include documenting the clinical significance of interventions, conducting multisite research concerning interventions, including interventions conducted in clinical settings, and implementing integrated clinical intervention and research. Training in empirically supported treatments and intervention research and developing policy related to intervention research would also promote a clinically relevant scientific agenda concerning intervention research with pediatric populations.

CONCLUSIONS

Pediatric psychologists have the opportunity to develop a clinically relevant science of interventions in pediatric settings by using multiple methods and strategies.

Bidirectional child-family influences on outcomes of traumatic brain injury in children

Child behavior problems, injury-related family burden, and parent psychological distress were assessed longitudinally over the first year post injury in 40 children with severe traumatic brain injury (TBI), 52 with moderate TBI, and 55 with orthopedic injuries not involving brain insult. Parents rated children's preinjury behavior soon after injury. Postinjury child behavior and family outcomes were assessed at 6- and 12-month follow-ups. Findings from path analysis revealed both direct and indirect effects of TBI on child behavior and family outcomes, as well as cross-lagged child-family associations. Higher parent distress at 6 months predicted more child behavior problems at 12 months, controlling for earlier behavior problems; and more behavior problems at 6 months predicted poorer family outcomes at 12 months, controlling for earlier family outcomes. Support for bidirectional influences is tentative given that limited sample size precluded use of structural equation modeling. The findings nevertheless provide impetus for considering the influences of person-environment interactions on outcomes of TBI.

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI.

Child and family functioning 6 and 12 months after a serious pediatric fracture

BACKGROUND

Previous findings indicate that pediatric fractures can have adverse consequences for child adjustment and family functioning immediately after injury. However, longer term effects of the fractures are unknown. The purposes of the present prospective study were to examine the child and family outcomes of pediatric traumatic fractures at 6 months and 1 year after injury, and to identify injury and treatment factors associated with these outcomes.

METHODS

We evaluated 57 children 6 to 12 years of age with traumatic fractures requiring hospitalization. Using standardized measures and parent interview, we obtained measures of pre- and postinjury child and family functioning.

RESULTS

Although outcomes were primarily positive at 1 year after injury, child functional limitations and family stress were observed up to 6 months after injury. Lower extremity fractures had a more negative impact on families across all three assessment points. Children with fracture interventions that involved prolonged immobilization had more functional limitations at 6 months than children who were ambulatory. Family burden was higher at 1 month for the immobilized children, but not at later follow-up.

CONCLUSION

Some children and families experience adverse effects during the year after a serious pediatric fracture, especially if sustained in a lower extremity. Fracture stabilization that allows for greater ambulation may offer some benefits related to functional outcomes and family impact.

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI.

Situational analysis of parenting problems for caregivers of children with sickle cell syndromes

A situational analysis of problematic situations was conducted for 37 caregivers of children with sickle cell disease (SCD) who ranged in age from 5 to 13 years. Participants responded to a semistructured interview related to caring for a child with SCD. The interview included the domains of medication adherence, nutrition, minimizing and coping with pain episodes, social problems, academic difficulties, and children's expression of negative feelings related to having SCD. Caregivers described a total of 356 problems. Almost all caregivers reported experiencing problems with their children's nutrition (n = 35), minimizing pain episodes (n = 34), and their children expressing feelings about having SCD (n = 33). Moderately challenging and emotionally upsetting problems were reported for coping with pain episodes. The total number of problems was significantly higher for boys than for girls. Nutrition issues were more frequently reported for younger children. Findings have salient clinical implications for the care of children with SCD.

Neurobehavioral symptoms in childhood closed-head injuries: changes in prevalence and correlates during the first year postinjury

OBJECTIVE

To examine changes in the prevalence and correlates of neurobehavioral symptoms during the first year following childhood closed-head injuries (CHIs).

METHODS

Participants included 31 children with severe CHIs, 38 with moderate CHIs, and 53 with orthopedic injuries (OIs). Children and their families were assessed shortly after injury and at 6- and 12-month follow-ups. Parents rated 15 symptoms classified as either cognitive/somatic (C/S) or emotional/behavioral (E/B).

RESULTS

Both kinds of symptoms were more common in the CHI groups than in the OI group. C/S symptoms declined in the CHI groups over time, whereas E/B symptoms became relatively more common. Measures of injury severity, children's premorbid behavioral adjustment, and concurrent cognitive functioning predicted C/S symptoms. E/B symptoms were predicted by injury severity, concurrent cognitive functioning soon after the injury, and concurrent parent and family functioning later in time. Both types of symptoms contributed to the prediction of perceived family burden, with the relationships strengthening over time.

CONCLUSIONS

The findings indicate that the prevalence and correlates of neurobehavioral symptoms in childhood CHIs vary as a function of symptom type and time since injury.

Problem-solving abilities among mothers of infants with failure to thrive

OBJECTIVE

Maternal problem-solving abilities, as they related to specific child-rearing situations, were examined and compared among mothers of infants with failure to thrive (FTT) and a matched group of comparison mothers.

METHODS

Participants were 37 mothers of children diagnosed with FTT and 37 mothers with normally growing children matched on three child variables and five maternal variables. Participants were administered a means-ends problem-solving measure specific to parents of young children and measures of language ability, depression, negative affect, and stressful life events.

RESULTS

Multivariate analysis of covariance results supported our main study hypotheses that mothers of infants with FTT would generate fewer problem-solving strategies that would be judged of poorer quality (i.e., less likely to result in positive outcomes) than mothers of healthy, normally growing infants. There were no significant associations obtained among problem-solving variables and individual difference variables (e.g., depression, negative affect, and stressful life events).

CONCLUSIONS

Limited maternal problem-solving abilities may contribute to FTT by interfering directly with the quality of nurturance, feeling, and caloric intake the child receives. Recommendations are made for future research and interventions with mothers of children with FTT.

Cognitive functioning in children on dialysis and post-transplantation

We studied 124 children, 62 patient-subjects who had end-stage renal disease (ESRD) and 62 sibling-controls who closely matched the patient-subjects in terms of their ethnicity and their socioeconomic status, to discern whether children with ESRD would perform less well than their siblings on standardized achievement and intelligence quotient (IQ) tests, and to determine whether ethnicity would influence such results. The subjects were recruited from nine pediatric transplant and dialysis centers across the United States. Thirty-one subjects were white (Euro-American), 17 were African-American, and 14 were categorized as 'other'. The average age of the patient-subjects was 13.7 +/- 0.44 yr; and of the sibling-controls 13.7 +/- 0.38 yr. Most patients (61%) and siblings (84%) were in regular school classes, and most (87% and 92%, respectively) attended school full-time. The average IQ percentile rank for the patients was significantly lower than their siblings (31 +/- 4 vs. 44 +/- 5, respectively, with normal = 50). Patients tended to score lower on achievement tests compared with their siblings (spelling: 88.7 +/- 4 vs. 94.6 +/- 2; arithmetic: 88.5 +/- 2 vs. 94.0 +/- 2; reading: 91.9 +/- 2 vs. 100 +/- 3, respectively). Patients scores on achievement tests were influenced by age at diagnosis and by the mother/caregiver's lower achievement. Also, increased time on dialysis predicted lower scores on achievement tests. Neither dialysis/transplant status nor ethnicity significantly affected outcome. Our data suggest that ESRD, but not ethnicity or dialysis/transplant status, is a risk factor for lower IQ and academic achievement, especially in younger children, in children who spend more time living with ESRD, and in children whose mother's/caregiver's have lower educational levels.

Prevalence and correlates of depressive symptoms following traumatic brain injuries in children

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.

Health-related quality of life in childhood cancer: discrepancy in parent-child reports

The purpose of our study was to describe reports of parents and of children with cancer on items taken from 4 domains of health-related quality of life (HRQL), bodily pain/distress, general health perceptions, physical functioning and limitations in role/social functioning as a result of physical health, and to examine whether differences in parent-child reports varied as a function of the child's health condition (cancer vs. healthy). Twenty-seven child-parent dyads with cancer and 27 child-parent dyads who were healthy (child ages 8 to 18 inclusive) completed measures of child HRQL [Child Health Questionnaire-Parent Form (CHQ-PF50) and Child Health Questionnaire (CHQ-CF87)] and demographic information at a scheduled out-patient general pediatric or pediatric oncology clinic appointment. Sixteen items included on both the CHQ-CF87 and CHQ-PF50 were examined to compare parent and child reports of child HRQL. As hypothesized, greater discrepancies were evident in the reports of parents of children with cancer than parents of children who are healthy [F(16,31) = 3.98, p < 0.0001]. Statistically significant discrepancies emerged in parent and child responses on 50% of the items in the sample of children with cancer, with parents reporting that their children experience more limitations in their lives than did the children themselves. In the healthy group, statistically significant discrepancies emerged on only 1 of the 16 items (6.3%).

The allocation of family responsibility for asthma management tasks in African-American adolescents

The allocation of responsibilities for asthma management within African-American families was examined in 60 adolescents and their primary caretakers. Separate structured interviews were conducted with adolescents and primary caretakers, and perceptions of family management, adherence to asthma treatment regimen, and functional morbidity were assessed. Support for the primary hypothesis that higher levels of nonadherence and functional morbidity would be observed in families where caretakers overestimated the level of adolescent involvement in asthma self-care was found. Implications for family-based asthma management in ethnic minority adolescents are discussed.

Diagnosis, disclosure, and informed consent: learning from parents of children with cancer

PURPOSE

The aim of this study was to learn about and to describe retrospective perceptions of parents of the circumstances of their child's cancer diagnosis and of the informed consent process.

METHODS

Professional moderators conducted three focus groups with 22 parents of children with cancer who were eligible for enrollment in a Children's Cancer Group clinical trial research protocol. Each focus group consisted of seven to nine parents and was audiotaped and transcribed.

RESULTS

Parents' descriptions of the early phase of their child's illness yielded the following themes: dialogues regarding the diagnosis and treatment options occurred amidst tremendous stress; a sense of constraint and lack of control were common; parents experienced variable degrees of choice regarding their child's participation in a clinical trial; and parents provided suggestions about how to improve the informed consent process. Overall, parents did not verbalize distinctions between their understanding of their child's medical treatment, research participation, and other aspects of their child's cancer experience.

CONCLUSIONS

Based on these results, the authors conclude with practical recommendations for health care professionals caring for children with cancer and call for future research about parents' understanding of treatment options, the nature of clinical trials, and experience with the diagnostic and early treatment phase of childhood cancer with larger samples of parents from multiple sites.

The diagnostic and statistical manual for primary care (DSM-PC), child and adolescent version: what pediatric psychologists need to know

OBJECTIVE

To address the need for a comprehensive, developmentally appropriate method to facilitate primary care pediatricians' recognition, management, and referral of a wide spectrum of childrens' behavioral and developmental problems, as well as stressful situations.

METHODS

Use of the Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version can facilitate psychologists' abilities to conduct research concerning the prevalence of behavioral and developmental problems, describe collaborative practice in primary care, and train pediatricians to recognize and manage common behavioral and developmental problems.

CONCLUSIONS

Strategies to enhance utilization of the DSM-PC include more widespread dissemination of information concerning the manual and its practical utility, promotion of reimbursement for its use, and documenting applications of the DSM-PC in teaching, practice, and research.

A psychological behavioral screening service: use, feasibility, and impact in a primary care setting

OBJECTIVE

To describe a psychology behavioral screening service and the use of the service in subsequent primary care provider (PCP) treatment decisions.

METHODS

The goal of the behavioral screening service was to obtain standardized parent and teacher rating scale data for children identified by PCPs as having possible behavioral problems. Medical chart review data were collected on 147 children for 1 year following screening to evaluate (1) PCP follow-up of the behavioral concern, (2) prescription of psychotropic medications, (3) referral to mental health services, and (4) receipt of mental health services.

RESULTS

Children screened by this psychology service had clinically significant behavioral problems, according to both parent and teacher data; PCPs appeared to use screening results to guide decisions about medication prescription but not mental health referrals. Children with more behavioral problems were more likely to be prescribed psychotropic medications and to be seen by a mental health professional.

CONCLUSIONS

These data suggest that a psychology behavioral screening service is feasible and may help guide PCP treatment decisions for children with behavior problems, particularly regarding the prescription of psychotropic medication.

Knowledge of physician prescriptions and adherence to treatment among children with cystic fibrosis and their mothers

This investigation examined factors related to adherence to treatment regimens for children with cystic fibrosis (CF) and their mothers. Subjects were 45 children with CF who ranged in age from 6 to 10 years and their mothers. Findings revealed that children's and parents' reports of level of adherence were related to their knowledge of the specific details associated with medically prescribed treatments. In this sample, 12% to 32% of mothers did not have an accurate understanding of physician recommendations for their children's treatments. When controlling for individual differences in the prescribed treatment regimens, parents' and children's knowledge of what had been prescribed accounted for a significant portion of the variance in the children's reported treatment-related behaviors. Results are discussed in terms of implications for future intervention research aimed at enhancing adherence to treatment as well as for future directions for clinical efforts in this area.

The family burden of injury interview: reliability and validity studies

OBJECTIVE

To assess the reliability and validity of a new instrument, the Family Burden of Injury Interview (FBII) was designed to assess the impact of childhood traumatic head injuries (THI) on the family.

PARTICIPANTS

99 Mothers of school-age children who experienced THI.

RESULTS

The FBII Total Score revealed group differences between families of children with severe THI and families of children with moderate THI. The measure also showed concurrent and predictive relationships to measures of the general impact of injury on families and maternal and child functioning.

CONCLUSION

The FBII is a promising tool for measuring the impact of injury-related stressors on the family.

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.

Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury

Examined posttraumatic stress (PTS) symptoms in children following pediatric traumatic brain injury (TBI). Children (ages 6-12) with TBI (n = 81) and orthopedic injury (OI; n = 59) were assessed 6 and 12 months postinjury. Parents of children with severe TBI reported higher levels of child PTS symptoms than did parents of children with moderate TBI or OI at the 6- and 12-month follow-ups. Group differences in child-reported PTS symptoms emerged at the 12-month follow-up with higher symptom levels reported by children with severe TBI than by those with moderate TBI or OI. At both follow-ups, rates of clinically significant symptom levels were higher in the severe TBI group than in the moderate TBI or OI groups. The group differences in parent and child reports were significant even after taking ethnicity, social disadvantage, and age at injury into account. Parent and child reports of child PTS symptoms were related to family socioeconomic status. Implications for clinical intervention with children and families following pediatric TBI are discussed.

Who participates in research on adherence to treatment in insulin-dependent diabetes mellitus? Implications and recommendations for research

OBJECTIVE

Examine the implications of nonparticipation in studies of treatment adherence among adolescents with chronic health conditions.

METHODS

Empirical data from an adherence study with adolescents with diabetes were used to demonstrate the influence of family participation on demographic and health outcome variables. Ninety-four families were categorized into one of three groups: (1) families that declined to participate in the study at recruitment (nonconsenters), (2) families that agreed to participate, but failed to return the study questionnaires (nonreturners), and (3) families that had at least one family member return the questionnaires (participants).

RESULTS

Despite being similar demographically, nonreturners had significantly lower treatment adherence scores and the adolescents tested their blood sugar less frequently than participants. Participants and non-consenters did not differ on any available data.

CONCLUSIONS

We discuss the implications of these group differences on the generalizability of research findings, offer suggestions about how to maximize and maintain participation in research studies, and suggest directions for future research.

Influences on first-year recovery from traumatic brain injury in children

This study examined recovery over the first year following traumatic brain injury (TBI) in children 6-12 years of age. Forty-two children with severe TBI and 52 with moderate TBI were compared to 58 children with orthopedic injuries. The children and their families were evaluated at a baseline assessment and at 6- and 12-month follow-ups. Findings documented cognitive, achievement, and behavioral sequelae of TBI, with only limited evidence for recovery over the first year postinjury. Outcomes were predicted by preinjury factors, TBI severity, and measures of the postinjury family environment. Some of the sequelae of severe TBI were more marked in the context of higher compared with lower levels of family burden or dysfunction. The findings confirm the need to consider environmental contributions to outcomes of TBI in children.

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.

Influences on first-year recovery from traumatic brain injury in children

This study examined recovery over the first year following traumatic brain injury (TBI) in children 6-12 years of age. Forty-two children with severe TBI and 52 with moderate TBI were compared to 58 children with orthopedic injuries. The children and their families were evaluated at a baseline assessment and at 6- and 12-month follow-ups. Findings documented cognitive, achievement, and behavioral sequelae of TBI, with only limited evidence for recovery over the first year postinjury. Outcomes were predicted by preinjury factors, TBI severity, and measures of the postinjury family environment. Some of the sequelae of severe TBI were more marked in the context of higher compared with lower levels of family burden or dysfunction. The findings confirm the need to consider environmental contributions to outcomes of TBI in children.

Acute psychosocial impact of pediatric orthopedic trauma with and without accompanying brain injuries

BACKGROUND

The acute psychosocial effects of orthopedic injuries on children and their families are poorly understood. Previous studies have relied on retrospective reports or failed to take into account accompanying brain injuries. The purpose of the present study was to examine prospectively the psychosocial impact of pediatric orthopedic traumatic fractures with and without accompanying brain injuries.

METHODS

Participants were 108 children 6 to 12 years old with orthopedic injuries requiring hospitalization: group 1 (n=80) had fractures only, group 2 (n=28) also had moderate or severe brain injuries. Using standardized measures and parent interviews, we obtained preinjury estimates of family functioning and child behavior problems and postinjury measures of parental distress, family stresses, and child behavior.

RESULTS

Parents reported significant clinical distress (35% in group 1, 57% in group 2), family burdens (group 2 > group 1), and child behavioral changes (41% in group 1, 89% in group 2). Multiple regression analyses indicated that preinjury family status and brain injuries predicted postinjury parental and family distress.

CONCLUSION

Pediatric orthopedic injuries have greater social effects on children with accompanying brain injuries and poorer preinjury family functioning.

Family burden and adaptation during the initial year after traumatic brain injury in children

OBJECTIVE

Traumatic brain injury (TBI) often leads to long-term behavioral and cognitive deficits in children. However, little is known about the burden and psychosocial morbidity of pediatric TBI for families. The purpose of this study was to test the hypothesis that moderate and severe TBI in children has more adverse consequences than orthopedic trauma.

DESIGN

The sample was comprised of children between the ages of 6 and 12 recruited from hospital trauma and inpatient units including 53 with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries not involving central nervous system insult. Measures of injury-related burden, parental distress, and family functioning were administered to the child's primary caregiver at baseline assessment conducted soon after injury and at 6- and 12-month follow-ups. Multivariate repeated measures analysis of covariance was used to examine group differences in these outcomes over time.

RESULTS

Caregivers in the severe TBI group reported significantly higher levels of family burden, injury-related stress, and parental psychological symptoms than caregivers in the orthopedic injury group (ORTHO). The groups did not differ with respect to marital distress. Caregivers in the severe TBI group were significantly more likely than caregivers in the ORTHO group to exceed the clinical cutoff on the Brief Symptom Inventory and to report clinically significant levels of family dysfunction at follow-up.

CONCLUSIONS

The findings suggest that severe TBI is a source of considerable caregiver morbidity, even when compared with other traumatic injuries. Caregivers in the severe TBI group had persistent stress associated with the child's injury, as well as the reactions of other family members, and a relative risk of clinically significant psychological symptoms nearly twice that of the ORTHO comparison group. These findings underscore the need for interventions that facilitate family adaptation after pediatric TBI.

Social competence among children with central nervous system-related chronic health conditions: a review

Reviewed empirical studies of social competence among children with central nervous system (CNS)-related chronic health conditions published since 1975. The overwhelming majority of studies evaluated social competence at the level of social adjustment; the domains of children's social performance and social skills were relatively neglected (Cavell, 1990). Findings are critiqued with respect to conceptualization of social competence among children with CNS conditions and methodological considerations. Directions for future research include expanding the conceptualization of social competence in this population to include social demands and competencies specific to children with CNS conditions and utilizing explicit theoretical frameworks that allow for competing hypotheses to be tested.

Preinjury family environment as a determinant of recovery from traumatic brain injuries in school-age children

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than environmental factors as predictors of recovery. We addressed this concern using data collected during a prospective study of children with either TBI or orthopedic injuries (OI) and their families. Participants included 53 children with severe TBI, 56 with moderate TBI, and 80 with OI, all from 6 to 12 years of age at the time of injury. Measures of the preinjury family environment were collected shortly after the injury (baseline). Child cognitive and behavioral outcomes were assessed at baseline and at 6- and 12-month follow-ups. Individual growth curve analyses showed that measures of the preinjury family environment consistently predicted both the level of cognitive and behavioral functioning at 12 months postinjury and the rate of intraindividual change during the 12-month follow-up period, even after taking into account group membership and injury severity. In some cases, the preinjury family environment was a significant moderator of the effect of TBI, buffering its impact in high-functioning families and exacerbating it in low-functioning families. Thus, preinjury environmental factors predict recovery following TBI in children, even after accounting for injury-related variables.

Intervention research: pushing back the frontiers of pediatric psychology

Intervention research in pediatric psychology assumes special importance given continuing pressures to develop and document the efficacy of interventions for pediatric populations. Studies presented in this issue illustrate the need for flexible approaches to intervention research including case studies and randomized trials, comprehensive assessment of health and psychological outcomes, assessment of social validity, identification of moderators of intervention effects, innovative treatment applications and strategies to integrate research and practice. Recommendations to enhance the scientific basis and clinical relevance of intervention research include using case series to document promising methods, collecting data in practice settings, assessing costs versus benefits, defining and assessing quality of psychological interventions, and conducting randomized clinical trials.

Neurodevelopmental outcomes of Ugandan infants with human immunodeficiency virus type 1 infection

BACKGROUND

The neurodevelopmental outcomes of human immunodeficiency virus type 1 (HIV-1)-infected Ugandan infants of nondrug-using mothers were studied using controlled, prospective methodology.

METHOD

The sample of 436 full-term infants included 79 HIV-infected infants of HIV-1-infected mothers, 241 uninfected infants of HIV-1-infected mothers (seroreverters), and 116 uninfected infants born to HIV-negative mothers. Neurologic status, information processing ability, and motor and mental development were assessed from 6 to 24 months of age. Observations of caretaker-child interaction and home environments were made at 6 and 12 months. All evaluators were blinded to the HIV status of the child and family.

RESULTS

Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated greater deficits in motor development and neurologic status, and more frequent and earlier onset of motor and neurologic abnormalities. Compared with controls, HIV-infected infants had more abnormalities in mental development at 6 and 18 months and an earlier onset of abnormalities. By 12 months, 30% of HIV-infected infants demonstrated motor abnormalities and 26% cognitive abnormalities as compared with 11% and 6% among seroreverters and 5% and 6% among seronegative infants. HIV-infected infants (62%) demonstrated a higher probability of developing an abnormal neurologic examination by 12 months, compared with seroreverters (17%) or seronegative infants (15%). Information-processing abilities did not differ as a function of HIV infection. Home environments and infants' interactions with caretakers were similar across groups.

CONCLUSION

We conclude that HIV infection results in more frequent and earlier abnormalities in infants' neurologic status and motor development that are not attributable to other biological and environmental risk factors. More frequent mental developmental abnormalities were evident at several ages. However, information-processing abilities, such as recognition memory, may be spared from HIV-related deficits.

Mothers' beliefs about the causes of infant growth deficiency: is there attributional bias?

Tested for defensive attributional bias in mothers' causal explanations for infant (2-12.5 months) growth deficiency. Mothers of healthy babies (controls; n = 82), growth deficient babies without medical problems (n = 27) and growth deficient babies with mild medical problems (n = 22) rated their levels of agreement with 23 causes of growth problems which were designed to vary in the degree of personal threat to parenting self-esteem. Ratings were completed for the mother's (Own) baby and for a nonspecific (Other) baby. Findings partially support a theory of defensive attributional bias, with higher agreement when causes referred to Other (vs. Own) baby, and lower agreement with family-related than with medical/nutritional causes. Factors that may have influenced material experience of threat and implications of the findings for clinical practice are discussed.

Relating parent and family functioning to the psychological adjustment of children with chronic health conditions: what have we learned? What do we need to know?

Reviewed research concerning the relationship of parent and family functioning to the psychological adjustment of children with chronic health conditions. More adaptive family relationships and parental psychological adjustment were associated with positive psychological adjustment while less adaptive family relationships (e.g., greater conflict and maternal psychological distress) consistently predicted problematic adjustment. Conclusions were limited by small, site-specific samples, reliance on self-report measures generally obtained from one parent, and general measures. Research progress would be enhanced by (a) more representative data sets; (b) process-oriented, illness-specific, and clinically relevant measures; (c) prospective analyses that clarify specific causal pathways between family functioning and children's adjustment; and (d) tests of interventions that modify risk and/or resistance factors.

Correlates of psychological distress among mothers of children and adolescents with hemophilia and HIV infection

Evaluated the correlates of mood state (psychological distress) in a multisite study of two groups: (a) mothers of HIV-positive children and adolescents with hemophilia (n = 91), and (b) mothers of HIV-negative children and adolescents with hemophilia (n = 92). Socioeconomic status, quality of family relationship support, and frequency of negative life events accounted for significant variance in Total Mood Disturbance (psychological distress) as measured by the Profile of Mood States in the overall sample. Severity of hemophilia was unrelated to distress. A significant interaction between HIV status and frequency of stressful life events indicated that this variable related more strongly to distress among mothers of HIV-infected children and adolescents with hemophilia than among mothers of HIV-negative children with hemophilia. Findings suggest that the presence of HIV infection in their children and adolescents may heighten the impact of negative life events on the psychological distress experienced by these mothers.