Parenting, self-regulation, and treatment adherence in pediatric chronic headache: A self-determination theory perspective

This study examined parenting factors associated with children’s self-regulation and physician-rated treatment adherence using a self-determination theory framework in pediatric chronic headache. Participants were 58 children and adolescents (aged 10–17 years), who underwent initial and follow-up multidisciplinary evaluation at a headache clinic, and their mothers. Regression analyses showed that higher maternal autonomy support and structure were significantly related to children’s lower treatment-related reactance and higher adherence. Maternal controllingness had associations in the opposite directions. Children’s fear of pain was related to maternal controllingness. Results suggest the importance of parents’ provision of clear expectations and engaging children in treatment problem-solving and decision-making

What Caregivers Like the Most (and Least) About Cognitive Behavioral Therapy for Youth Anxiety: A Mixed Methods Approach

Cognitive behavioral therapy (CBT) is an efficacious therapy for youth anxiety disorders. Caregivers are key stakeholders in youth therapy, and their feedback on treatment can help to inform intervention personalization. This mixed-methods study applied a systematic inductive thematic analysis to identify themes among most- and least-liked CBT features reported by caregivers using open-ended responses on the Client Satisfaction Questionnaire (CSQ-8). The sample included 139 caregivers of youth ages 7-17 (M = 12.21, SD = 3.05; 59% female; 79.1% Caucasian, 5.8% Black, 2.9% Asian, 2.2% Hispanic, 7.9% multiracial, 2.2% Other) with principal anxiety diagnoses who completed 16-sessions of CBT. CSQ-8 quantitative satisfaction scores (M = 29.18, SD = 3.30; range: 16-32) and survey-based treatment response rates (responders n = 93, 67%) were high. Most-liked treatment features included: coping skills (i.e., exposure, understanding/identifying anxiety, rewards, homework), therapist factors (interpersonal style/skill, relationship, accessibility), caregiver involvement, one-on-one time with a therapist, structure, consistency, and personally tailored treatment. Least-liked treatment features included: questionnaires, logistical barriers, telehealth, need for more sessions, non-anxiety concerns not addressed, insufficient caregiver involvement, and aspects of exposure tasks. Proportional frequencies of most- and least-liked themes differed by treatment responder status (e.g., responders cited exposure and homework as most-liked more frequently)

Children’s Literature on Anxiety: A Systematic Review and Content Analysis

Objective: Children’s literature can teach life lessons and effective coping strategies, and can be a way to disseminate evidence-based practices (EBPs) for mental health as a universal prevention strategy. We conducted a content analysis on the presence of EBPs for youth anxiety in children’s literature picture books about anxiety. Method: Analytic plan was preregistered on OSF. 1640 books were screened, and 191 books were coded for eight EBPs for youth anxiety: psychoeducation, labeling body sensations, relaxation, identifying/challenging anxious thoughts, problem solving, contingency management (e.g., rewards and praise), approaching-anxiety provoking situations (i.e., exposure), and post-approach processing. Results: Characters in the books modeled an average of 2.39 EBPs (SD = 1.76). The most frequently modeled EBPs were identifying/challenging anxious thoughts (60% of books), approaching-anxiety provoking situations (46%), and labeling body sensations (42%). The least commonly modeled EBP was contingency management (7%). Books written by licensed therapists were more likely to demonstrate post-approach processing. Books with self-help information at the end were more likely to model post-approach processing and relaxation skills. Books written for youth age 9-12 years modeled more EBPs than books written for youth age 8 years and younger. Conclusions: Children’s books on youth anxiety model relatively few EBPs. Although approaching anxiety-provoking situations was one of the most used EBPs, 54% of books with an anxious character do not model having that character face their fears–a key strategy for youth anxiety. Additionally, few books demonstrate use of rewards and praise by caregivers, who often read stories with their children. Clinicians, caregivers, and librarians are encouraged to purchase books written by therapists or with self-help information in the back, given that these books are more likely to model EBPs

Do youth anxiety measures assess the same construct consistently throughout treatment? Results are...complicated.

Interventionists interpret changes in symptoms as reflecting response to treatment. However, changes in symptom functioning and the measurement of the underlying constructs may be reflected in reported change. Longitudinal measurement invariance (LMI) is a statistical approach that assesses the degree to which measures consistently capture the same construct over time. We examined LMI in measures of anxiety severity/symptoms [i.e., Pediatric Anxiety Rating Scale (PARS), Multidimensional Anxiety Scale for Children (MASC), Screen for Child Anxiety and Related Disorders (SCARED)] in anxious youth at baseline and posttreatment. Initial fit was inadequate for 27 of 38 baseline and posttreatment models, but model modifications resulted in acceptable fit. Tests of LMI supported scalar invariance for the PARS and many, but not all, MASC and SCARED subscales. Findings suggest that the PARS, and many MASC and SCARED subscales can accurately be used to measure change over time, however, others may reflect changes in measurement properties

Rapid Screening of Risk in Pediatric Headache: Application of the Pediatric Pain Screening Tool

Objective: The current study examined the application of a screening tool to identify biopsychosocial risk factors and derive prognostic risk groups in children and adolescents with headache pain.Methods: Youth (n = 242, 8-17 years, 75.6% female) presenting for evaluation at a tertiary pediatric headache clinic completed the nine-item Pediatric Pain Screening Tool (PPST) as well as measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. In addition, 119 patients reported on functional disability at 2-month follow-up.Results: The PPST demonstrated discriminant validity that ranged from fair to good for identifying significant disability and high emotional distress. Receiver operating characteristic curve analyses indicated that established cutoff scores were appropriate for the current sample, and thus participants were classified into low-risk (21%), medium-risk (31%), and high-risk (48%) groups. Only 1-6% of patients who met reference standard case status for disability and emotional distress were classified as low risk, whereas 64-90% of patients who met reference standard case status were classified as high risk, suggesting robust stratification.Conclusions: The nine-item PPST may be a useful tool for efficiently identifying young patients with headache who are at risk of poor outcomes, and effectively classifying them into risk groups that could drive stratified treatment directly targeting patient needs.</p