Stuck in an Existential Quagmire: The Role of Perceived True Self-Knowledge in Client Stuckness

Introduction: Research suggests that perceived true self-knowledge is important for well-being. However, less discussion exists about how perceived true self-knowledge affects therapy outcomes. We suggest that perceived true self-knowledge may be important when attempting to address client stuckness (i.e., lack of progress in therapy; Beaudoin, 2008). We argue that when clients perceive a lack of true self-knowledge, they are unable to draw upon the true self-concept as a source of meaning. This may hinder therapeutic progress and contribute to client stuckness.

Methods: We present theoretical evidence for the role of perceived true self-knowledge in experiences of stuckness. Then, we present case studies of two stuck clients and their therapeutic interventions as preliminary evidence for our model.

Results: Direct strategies geared at enhancing true self-knowledge by helping the client construct coherent self-concepts worked for one client, but not for the other. Indirect strategies, grounded in social psychological research, are outlined as a method of enhancing perceptions of true self-knowledge for clients who do not benefit from direct strategies.

Discussion: Potential moderators for the effectiveness of direct versus indirect strategies to enhance true self-knowledge are discussed. We then outline promising avenues for future research that include attempts to investigate the prevalence of self-alienation in clinical populations, and the effectiveness of strategies aimed at enhancing perceived true self-knowledge among clients experiencing stuckness.

Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module for youth with Type 2 diabetes: reliability and validity

AIM

To test the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module originally developed in Type 1 diabetes in youth with Type 2 diabetes.

METHODS

The PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were administered in a field test study to 100 young people aged 9-25 years with Type 2 diabetes. Factor analysis was conducted to determine the factor structure of the items.

RESULTS

The 15-item Diabetes Symptoms Summary Score and 12-item Type 2-specific Diabetes Management Summary Score were empirically derived through factor analysis. The Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores showed acceptable to excellent reliability across the age groups tested (α = 0.85-0.94). The Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores evidenced construct validity through large effect size correlations with the Generic Core Scales Total Scale Score (r = 0.67 and 0.57, respectively). HbA_1c was correlated with the Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores (r = -0.13 and -0.22). Minimal clinically important difference (MCID) scores were 5.91 and 7.39 for the Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores.

CONCLUSIONS

The PedsQL 3.2 Diabetes Module Diabetes Symptoms Summary Score and Type 2-specific Diabetes Management Summary Score exhibited satisfactory measurement properties for use as youth self-reported diabetes symptoms and diabetes management outcomes for clinical research and clinical practice for young people with Type 2 diabetes.

Diabetes management mediating effects between diabetes symptoms and health-related quality of life in adolescents and young adults with type 1 diabetes

OBJECTIVES

The primary objective was to investigate the mediating effects of diabetes management in the relationship between diabetes symptoms and generic health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with type 1 diabetes. The secondary objective explored patient health communication and perceived treatment adherence barriers as mediators in a serial multiple mediator model.

METHODS

The PedsQL 3.2 Diabetes Module 15-item diabetes symptoms summary score, 18-item diabetes management summary score, and PedsQL 4.0 generic core scales were completed in a 10-site national field test study by 418 AYA aged 13 to 25 years with type 1 diabetes. Diabetes symptoms and diabetes management were tested for bivariate and multivariate linear associations with overall generic HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of diabetes management as an intervening variable between diabetes symptoms and generic HRQOL.

RESULTS

The predictive effects of diabetes symptoms on HRQOL were mediated in part by diabetes management. In predictive analytics models utilizing multiple regression analyses, demographic and clinical covariates, diabetes symptoms, and diabetes management significantly accounted for 53% of the variance in generic HRQOL (P < 0.001), demonstrating a large effect size. Patient health communication and perceived treatment adherence barriers were significant mediators in an exploratory serial multiple mediator model.

CONCLUSIONS

Diabetes management explains in part the effects of diabetes symptoms on HRQOL in AYA with type 1 diabetes. Patient health communication to healthcare providers and perceived treatment adherence barriers further explain the mechanism in the relationship between diabetes symptoms and overall HRQOL.

PedsQL 3.2 Diabetes Module for Children, Adolescents, and Young Adults: Reliability and Validity in Type 1 Diabetes

OBJECTIVE

The objective of the study was to report on the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module for children, adolescents, and young adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS

The 33-item PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were completed in a 10-site national field test study by 656 families of patients ages 2-25 years with type 1 diabetes.

RESULTS

The 15-item Diabetes Symptoms Summary Score and 18-item Diabetes Management Summary Score were derived from the factor analysis of the items. The Diabetes Symptoms and Diabetes Management Summary Scores evidenced excellent reliability (patient self-report α = 0.88-0.90; parent proxy report α = 0.89-0.90). The Diabetes Symptoms and Diabetes Management Summary Scores demonstrated construct validity through medium to large effect size correlations with the Generic Core Scales Total Scale Score (r = 0.43-0.67, P < 0.001). HbA_1c was significantly correlated with the Diabetes Symptoms and Diabetes Management Summary Scores (r = -0.21 to -0.29, P < 0.001). Minimal clinically important difference scores ranged from 5.05 to 5.55.

CONCLUSIONS

The PedsQL 3.2 Diabetes Module Diabetes Symptoms and Diabetes Management Summary Scores demonstrated excellent measurement properties and may be useful as standardized patient-reported outcomes of diabetes symptoms and diabetes management in clinical research, clinical trials, and practice in children, adolescents, and young adults with type 1 diabetes.

Ethnicity as a moderator of how parents' attitudes and perceived stigma influence intentions to seek child mental health services

OBJECTIVE

Research has identified several variables that affect utilization of mental health services. However, more could be explored regarding ethnic differences among parents seeking help for their children.

METHOD

In our study, 238 caregivers were recruited from the southern United States to examine ethnic differences in intentions to access child mental health services with the Parental Attitudes Toward Psychological Services Inventory (Turner, 2012) as the primary measure.

RESULTS

Group comparisons indicated that African-American parents reported less positive attitudes and more stigma than European-American or Hispanic-American parents. Moderation analyses found (a) attitudes were associated with a higher level of parental help-seeking intention among European Americans, but not among African Americans or Hispanic Americans and (b) stigma was associated with a lower parent-reported likelihood of help-seeking for Hispanic Americans, but not for European Americans or African Americans.

CONCLUSIONS

Ethnicity deferentially impacts attitudes and stigma associated with seeking mental health services. Public education efforts to increase service use should be tailored toward under-served groups to be more effective.

A parent-focused pilot intervention to increase parent health literacy and healthy lifestyle choices for young children and families

Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low-income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children (1) health literacy information in an experiential manner and (2) practical skills to engage their families in healthy lifestyle choices. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting, and mental wellness. Postintervention improvements were noted for factual knowledge for diet/nutrition, physical activity, and sleep, beliefs about diet/nutrition, and the relationship between mental health and stress. Additionally, postintervention improvements were noted for general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, knowledge about common childhood sleep problems, and parents' bedtime interactions with children. The efficacy of the intervention should be evaluated on a larger, more diverse sample in the future with considerations for multiple health behavior change in the evaluation.

Impact of growing up with a chronically ill sibling on well siblings' late adolescent functioning

The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (M age = 18.78, SD = 0.83), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted.

Perceptions of preventive health care and healthy lifestyle choices for low income families: a qualitative study

This paper examines Head Start parents' perceptions of preventive health and healthy lifestyle choices and Head Start administrators' perceptions of the needs of parents they serve. To address the preventive health of the population, it is necessary that we explore perceptions, risks, and protective factors of preventive health. Focus groups were conducted with parents and administrators to elicit this information and to obtain suggestions for improving preventive health and healthy lifestyle choices among this group. Overall, nutrition and physical activity emerged as themes in parents' definition of preventive health and healthy lifestyle choices. They further identified social support and education as major protective factors for engaging in preventive health and healthy lifestyle choices. Results of this study can be used to inform research and practice to develop interventions to increase preventive health and healthy lifestyle choices among low income families.

Patient-reported Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales in pediatric patients with attention-deficit/hyperactivity disorder and comorbid psychiatric disorders: feasibility, reliability, and validity

OBJECTIVES

The primary objective of the study was to evaluate the feasibility, reliability, and validity of the Pediatric Quality of Life Inventory™ (PedsQL) 4.0 Generic Core Scales as a patient self-reported health-related quality of life measurement instrument in pediatric patients with attention-deficit/hyperactivity disorder (ADHD) and physician-diagnosed comorbid psychiatric disorders being seen in a pediatric psychiatric clinic. The secondary objective was to evaluate parent proxy-reported PedsQL in this population.

METHODS

One hundred seventy-nine children with ADHD and comorbid psychiatric disorders ages 5 to 18 years and 181 parents completed the PedsQL 4.0 Generic Core Scales and parents also completed the Vanderbilt ADHD Diagnostic Rating Scales. Known-groups discriminant validity comparisons were made between the sample of pediatric patients with ADHD and comorbid psychiatric disorders and healthy, cancer, and type 1 diabetes samples.

RESULTS

The PedsQL evidenced minimal missing responses for patient self-report and parent proxy-report (0.2% and 0.5%, respectively), demonstrated no significant floor or ceiling effects, and achieved excellent reliability for the Total Scale Score (α = 0.85 patient self-report, 0.92 parent proxy-report). Pediatric patients with ADHD and comorbid psychiatric disorders and their parents reported statistically significantly worse PedsQL scores than healthy children, with large effect sizes across all domains, supporting known-groups discriminant validity. Pediatric patients with ADHD and comorbid psychiatric disorders and their parents reported worse PedsQL scores compared to pediatric patients with cancer and diabetes with the exception of physical health, in which pediatric cancer patients manifested lower physical health, indicating the relative severe impact of ADHD and comorbid psychiatric disorders. More severe ADHD symptoms were generally associated with more impaired PedsQL scores, supporting construct validity.

CONCLUSIONS

These data demonstrate the feasibility, reliability, and validity of patient self-reported PedsQL 4.0 Generic Core Scales in this high risk population of pediatric patients and highlight the profound negative impact of ADHD and comorbid psychiatric disorders on generic health-related quality of life, comparable to or worse than serious pediatric chronic physical diseases.

The PedsQL™ Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants

OBJECTIVE

The PedsQL™ (Pediatric Quality of Life Inventory™) is a modular instrument designed to measure health-related quality of life (HRQOL) and disease-specific symptoms in children and adolescents ages 2-18. The new PedsQL™ Infant Scales were designed as a generic HRQOL instrument specifically for healthy and ill infants ages 1-24 months. The objective of this study was to report on the initial feasibility, internal consistency reliability, and validity of the PedsQL™ Infant Scales in healthy, acutely ill, and chronically ill infants.

METHODS

The 36-item (ages 1-12 months) and 45-item (ages 13-24 months) PedsQL™ Infant Scales (Physical Functioning, Physical Symptoms, Emotional Functioning, Social Functioning, Cognitive Functioning) were completed by 683 parents of healthy, acutely ill, and chronically ill infants.

RESULTS

The PedsQL™ Infant Scales evidenced minimal missing responses, achieved excellent internal consistency reliability for the Total Scale Scores (α = 0.92), distinguished between healthy infants and acutely and chronically ill infants, and demonstrated a confirmatory factor structure largely consistent with the a priori conceptual model.

CONCLUSIONS

The results demonstrate the initial measurement properties of the PedsQL™ Infant Scales in healthy and ill infants. The findings suggest that the PedsQL™ Infant Scales may be utilized in the evaluation of generic HRQOL in infants ages 1-24 months.

The PedsQL™ Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants

OBJECTIVE

The PedsQL™ (Pediatric Quality of Life Inventory™) is a modular instrument designed to measure health-related quality of life (HRQOL) and disease-specific symptoms in children and adolescents ages 2-18. The new PedsQL™ Infant Scales were designed as a generic HRQOL instrument specifically for healthy and ill infants ages 1-24 months. The objective of this study was to report on the initial feasibility, internal consistency reliability, and validity of the PedsQL™ Infant Scales in healthy, acutely ill, and chronically ill infants.

METHODS

The 36-item (ages 1-12 months) and 45-item (ages 13-24 months) PedsQL™ Infant Scales (Physical Functioning, Physical Symptoms, Emotional Functioning, Social Functioning, Cognitive Functioning) were completed by 683 parents of healthy, acutely ill, and chronically ill infants.

RESULTS

The PedsQL™ Infant Scales evidenced minimal missing responses, achieved excellent internal consistency reliability for the Total Scale Scores (α = 0.92), distinguished between healthy infants and acutely and chronically ill infants, and demonstrated a confirmatory factor structure largely consistent with the a priori conceptual model.

CONCLUSIONS

The results demonstrate the initial measurement properties of the PedsQL™ Infant Scales in healthy and ill infants. The findings suggest that the PedsQL™ Infant Scales may be utilized in the evaluation of generic HRQOL in infants ages 1-24 months.

Using the bioecological model to predict risk perception of marijuana use and reported marijuana use in adolescence

PURPOSE

The purpose of the study was to investigate the ability of the Bioecological Model (BEM) to predict adolescents' risk perception (RP) of marijuana use and reported marijuana use. The secondary aim of the study was to investigate the extent to which the BEM influenced adolescents' decision-making regarding marijuana use by exploring the BEM's ability to moderate the relationship between adolescents' RP of marijuana use and reported use.

METHODS

Systems in the proposed BEM included variables from the literature proven to influence adolescents' health risk behaviors. Hierarchical linear regression was used to predict RP from BEM variables. Hierarchical logistic regressions were used to predict marijuana use from BEM variables and to assess the ability of the BEM to moderate the relationship between RP and reported marijuana use.

RESULTS

Three systems in the BEM, Adolescent, Microsystem, and Mesosystem, were predictive of RP and reported marijuana use. At least two variables in each system predicted RP and reported marijuana use. The Mesosystem moderated the relationship between RP and use.

CONCLUSION

The combination of the BEM and the HBM provides the unique opportunity to understand adolescents' decision to engage in marijuana use. Because the BEM is viewed as part of a generative process, results here can be used to produce a more integrated HBM specific to adolescence.

Effects of posttraumatic stress and acculturation on marital functioning in Bosnian refugee couples

Forty Bosnian refugee couples living in the United States completed a translated version of the PTSD Symptom Scale--Self Report, the Behavioral Acculturation Scale, the Marital Satisfaction Inventory--Revised, and a demographic questionnaire. Posttraumatic stress disorder (PTSD) symptomatology was the best predictor of marital functioning and was related negatively to acculturation. After controlling for PTSD, acculturation did not predict marital functioning. Wives' marital satisfaction was best predicted by husbands' PTSD, husbands' acculturation, and their own PTSD. Husbands' marital satisfaction was not predicted significantly by any of these variables. These findings suggest several implications for mental health professionals dealing with refugees and other traumatized populations.

Self-concept and social competence of university student victims of childhood physical abuse

OBJECTIVE

This study examined the impact of childhood physical abuse on self-concept and social competency of older adolescents and assessed perception of parental relationships as a mediator for consequences of abuse on social adjustment.

METHOD

College undergraduates (n = 660) completed: (a) the Social Skills Inventory (SSI), a measure of social competence, (b) the Self-Description Questionnaire-III (SDQ-III), a multidimensional measure of self-concept, (c) the parent scales of the Inventory of Parent and Peer Attachment (IPPA), a measure of perceived parental support, and (d) the Assessing Environments-III (AE-III), a retrospective report of family environment and parenting practices.

RESULTS

Analyses, controlling for socioeconomic status and ethnicity, showed that a history of physical abuse was predictive of current self-concept, but did not predict social competence as an older adolescent. Further analyses lend support to a mediational model, suggesting that physical abuse has a negative impact on self-concept through its negative effect on parent-child relationships.

CONCLUSIONS

The findings indicate that childhood physical abuse has a negative impact on the self-concept of the older adolescent. However, this impact can be better understood by investigating its potentially harmful effect on parent-child relationships. The impact of physical abuse on adolescents' social competence was not supported in this study.

The effects of oral versus written instructions on parents' recall and satisfaction after pediatric appointments

This study explored the differential effects of written versus oral instructions on parents' recall of information and satisfaction after pediatric appointments. Ninety-six parents completed descriptive information and satisfaction ratings, and four pediatricians completed ratings concerning the complexity level of the appointment. After the appointment, parents were randomly assigned to the Written condition (to receive a transcription of the pediatrician's instructions) or Oral condition (verbal instruction only). Parents were telephoned 5 to 7 days later to report their recall of instructions and satisfaction with the appointment. For the Oral condition parents only, more previous appointments with a given pediatrician were associated with greater parental satisfaction and recall of instructions, and more previous appointments and more time spent with the pediatrician were related to fewer forgotten instructions. Parental characteristics, such as age, number of children, and occupational status, were associated with satisfaction and accurate recall. Implications of these findings are discussed.

Nonorganic failure to thrive: developmental outcomes and psychosocial assessment and intervention issues

Serious growth problems, such as Nonorganic Failure to Thrive (NFTT), place an infant/toddler at significant risk for poor developmental outcomes. Evidently, an NFTT child's malnutrition and subsequent poor growth and development are accentuated by a family context of impoverishment, dysfunctional relationships, inadequate education, and a dearth of developmentally enriching experiences. The purpose of this review is to describe NFTT, to present development outcomes, and to discuss psychosocial assessment and intervention issues relevant to this developmental disability of early childhood. An ideographic approach to case conceptualization, evaluation, and treatment is suggested to achieve successful developmental outcomes and to guide research endeavors.