A Randomised Controlled Trial of Written Self-Disclosure for Functional Recurrent Abdominal Pain in Youth

Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youths aged 11-18 years with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-min sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity and quality of life (QOL) were completed at baseline and 3- and 6-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilisation for the 6 months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting gastrointestinal pain experiences (d = 0.61) and reduced health care utilisation (d = 0.59) 6 months later compared to SMC alone. There were no significant effects for somatisation severity or QOL in 6 months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilisation in a portion of youths with functional RAP

A Randomised Controlled Trial of Written Self-Disclosure for Functional Recurrent Abdominal Pain in Youth

Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youths aged 11-18 years with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-min sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity and quality of life (QOL) were completed at baseline and 3- and 6-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilisation for the 6 months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting gastrointestinal pain experiences (d = 0.61) and reduced health care utilisation (d = 0.59) 6 months later compared to SMC alone. There were no significant effects for somatisation severity or QOL in 6 months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilisation in a portion of youths with functional RAP

Executive functions and social skills in survivors of pediatric brain tumor.

Medical advances have resulted in increased survival rates for children with brain tumors. Consequently, issues related to survivorship have become more critical. The use of multimodal treatment, in particular cranial radiation therapy, has been associated with subsequent cognitive decline. Specifically, deficits in executive functions have been reported in survivors of various types of pediatric brain tumor. Survivors are left with difficulties, particularly in self-monitoring, initiation, inhibition, and planning, to name a few. Another domain in which survivors of pediatric brain tumor have been reported to show difficulty is that of social skills. Parents, teachers, and survivors themselves have reported decreased social functioning following treatment. Deficits in executive functions and social skills are likely interrelated in this population, as executive skills are needed to navigate various aspects of social interaction; however, this has yet to be studied empirically. Twenty-four survivors of pediatric brain tumor were assessed using a computerized task of executive functions, as well as paper and pencil measures of social skills and real world executive skills. Social functioning was related to a specific aspect of executive functions, i.e., the survivors’ variability in response time, such that inconsistent responding was associated with better parent-report and survivor-report social skills, independent of intellectual abilities. Additionally, parent-reported real-world global executive abilities predicted parent-reported social skills. The implications of these findings for social skills interventions and future research are discussed

The influence of perceived racial bias and health-related stigma on quality of life among children with sickle cell disease

OBJECTIVES: Individuals with sickle cell disease (SCD) experience significant health problems that may result in unpredictable pain episodes and frequent healthcare utilization. Disparities in clinical care may contribute to health-related stigma and racial bias for this majority African-American/Black population. There is less known about the influence of health-related stigma and racial bias on the health-related quality of life (HRQOL) of children with SCD. In the present study, we assessed these relationships and identified differences across demographic factors (i.e., age, gender). DESIGN: Data was collected from African American children with SCD aged 8 – 16 years (57% male, 63% HbSS). Children completed the Childhood Stigma Scale (adapted for SCD), the Child Perceptions of Racism in Children and Youth scale, and the Pediatric Quality of Life Inventory Sickle Cell Disease Module. Caregivers provided demographic information. RESULTS: In the first regression model, health-related stigma (p = .007) predicted HRQOL, but neither age nor gender were significant predictors. In the second regression model, age (p = .03) predicted HRQOL, but neither gender nor racial bias were significant predictors. Of interest, there was a significant interaction between age, gender, and racial bias (p = .02). Specifically, older girls who reported high levels of perceived racial bias had poorer HRQOL. CONCLUSIONS: Our study highlights the need for increased awareness about the effects of health-related stigma and racial bias on HRQOL for children with SCD, particularly for older girls who endorse racial bias. Our findings will guide future stigma and bias reduction interventions that may meet the needs of older girls with SCD

Pain-Related Injustice Appraisals in Youth with Sickle Cell Disease:A Preliminary Investigation

Objectives: Sickle cell disease (SCD) is a genetic disorder that affects approximately 100,000 Americans, the majority of whom are African American. SCD-related pain often has deleterious effects on functioning and quality of life. The inherited nature of SCD, SCD-related stigma, and serious physical and functional impact of SCD-related pain create a situation ripe for individuals to appraise their SCD-related pain as unfair or unjust. The aim of this preliminary investigation is to explore the extent to which pediatric patients with SCD appraise their pain as unjust and how these appraisals relate to functioning. Methods: Participants were youth with SCD (N = 30, mean age = 11.3, 57% boys) who attended a hematology clinic visit. Patients were invited to complete paper-based questionnaires assessing pain-related injustice appraisals, pain catastrophizing, pain and hurt, functional disability, depression, anxiety, and peer relationships. Results: Results of hierarchical regressions indicate that pain-related injustice significantly predicted functional disability, depression, and anxiety after controlling for patient pain and catastrophizing. Conclusions: These findings suggest that pain-related injustice appraisals are an important contributor to the pain experience of youth with SCD. Early identification and remediation of pain-related injustice appraisals could have long-term functional benefits for youth with SCD

Psychosocial Assessment as a Standard of Care in Pediatric Cancer

This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family resources, family/social support, previous history/premorbid functioning, and family structure/function. Descriptive quantitative studies, systematic reviews, and meta-analyses (n = 149) were reviewed and evaluated using grading of recommendations, assessment development, and evaluation (GRADE) criteria. There is high quality evidence to support a strong recommendation for multifaceted, systematic assessments of psychosocial health care needs of youth with cancer and their families as a standard of care in pediatric oncolog