The Relationship Between Adolescent Renal Transplant Recipients' Perceived Adversity, Coping, and Medical Adherence

Abstract The aim of the present study was to assess adolescent renal transplant recipients' perceived adversity (PA) for various aspects of living with a transplant, including its association with coping and medication nonadherence, from a theoretical perspective. Thirty-three adolescent renal transplant recipients were interviewed using structured questionnaires and medical record reviews. Health care provider ratings of adversity were also collected. Participants reported moderate levels of PA, with those who received a transplant at an older age reporting more adversity on several domains and girls reporting more adversity for missing school. Ratings of adversity for specific aspects of living with a transplant differed depending on age and medical factors and were related to specific coping strategies and measures of non-adherence. Consistent with the Self-Regulation Model, perceived consequences (represented as PA) appears to be related to coping and illness outcomes. Assessing PA and teaching appropriate coping strategies may yield better medical outcomes among this at-risk population

Pediatric Procedural Pain

Reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures, and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs are discussed and recommendations provided. Pharmacological, other medical approaches, and empirically supported cognitive behavioral interventions are reviewed. Salient features of the interventions are discussed and recommendations are made for necessary components of effective treatment interventions

Factors Associated With Healthcare Utilization Among Children With Noncardiac Chest Pain and Innocent Heart Murmurs

Objective To examine differences in factors related to health care utilization (HCU) among children eventually diagnosed with noncardiac chest pain (NCCP) or an innocent heart murmur (IHM). Methods 67 pediatric patients with NCCP and 62 with IHM and their parent/guardian completed paper-and-pencil measures of psychological functioning and past HCU during an initial visit to the cardiologist's office. Results Children with NCCP utilized significantly more health care services compared to their IHM counterparts in the year prior to their cardiology visit. Children in the NCCP group had higher internalizing and somatic symptoms, and their parents experienced more anxious symptoms, than those in the IHM group. For the NCCP group only, child and parent psychological symptoms and parent HCU were positively related to child HCU. Conclusions Results identify possible child and parent psychological factors that may be the focus of interventions to reduce high rates of HCU among children with NCCP

Behavioural assessment of pediatric pain

Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence-Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. The characteristics of the eight behavioural assessment scales that were recommended by one of these task forces are further reviewed in the present paper. The results indicate that behavioural assessment scales have been used flexibly to assess pain in a wide variety of situations, across different pediatric populations and for patients of different ages. In the present review, there appears to be no basis for designating the scales as measures of distress versus pain; both emotional and sensory components of pain seem to be assessed by each of the scales. There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children’s coping and adults’ behaviours, as well as pain

Children’s pain threat appraisal and catastrophizing moderate the impact of parent verbal behavior on children’s symptom complaints

Objective We tested the hypothesis that pain threat appraisal and catastrophizing by children with functional abdominal pain (FAP) will moderate the relation between parent verbal behavior and children's symptom complaints following experimentally induced visceral discomfort. Methods Thirty-three pediatric patients with FAP and their parents participated. Children completed measures of pain threat appraisal and catastrophizing. Weeks later they completed the Water Load Symptom Provocation Test to induce visceral discomfort. Spontaneous parent-child interactions during child discomfort were audiotaped and coded for content. Results Parent symptom-related talk was associated with more child symptom complaints and parent non-symptom-related talk with fewer child complaints. The relation between symptom talk and complaints was greater for children with high catastrophizing. Non-symptom talk was associated with fewer complaints for children with high threat appraisals. Conclusions Child characteristics should be considered in research on the relation between parent behavior and children's symptom complaints