Motivational interviewing with parents of overweight children: Study design and methods for the NOURISH+MI study

There is an urgent need for innovative approaches to pediatric obesity treatment. There is also a demand for targeted strategies that reduce attrition and improve treatment adherence. Intervening exclusively with parents of overweight children is a novel approach with demonstrated efficacy in reducing child body mass index (BMI) percentile. Motivational interviewing (MI), a brief communication style for exploring and resolving ambivalence about behavior change, might enhance treatment engagement when implemented as part of obesity interventions. The aim of this report is to provide the rationale and methods for a novel study of MI with parents in the treatment of their children’s overweight. We designed and are currently implementing NOURISH+MI, a randomized controlled trial examining the feasibility and efficacy of an adjunct values-based MI intervention, implemented within a culturally-tailored parent intervention for overweight children ages 5-11 years, NOURISH+ (Nourishing Our Understanding of Role modeling to Improve Support and Health). Specifically, we are randomly assigning 60 parents to this adjunctive treatment, and investigating if adding two MI sessions prior to the NOURISH+ group intervention will enhance treatment effects. We will be able to compare NOURISH+MI participants with those from the two NOURISH+ treatment conditions (NOURISH+ and control). We hypothesize that children whose parents participate in NOURISH+MI will demonstrate lower attrition and greater adherence with NOURISH+, ultimately leading to greater treatment effects, compared with children whose parents are randomized to NOURISH+ or a control group. Findings will contribute to the emerging literature examining the efficacy of MI within pediatric obesity interventions

Glycemic Control as a Function of Breakfast Macronutrients and Physical Activity Timing in Young Children with Type 1 Diabetes

Background: Incidence of T1D is increasing in young children (\u3c 7 years). During this sensitive developmental period, daily medical regimens are needed to prevent T1D complications commonly seen later in life. Diabetes management for young children relies solely on parents, and factors related to glycemic control and variability have not been well studied in this age group. Objective: To characterize blood glucose (BG), energy expenditure, diet and physical activity (PA) patterns in a small cohort of young children with type 1 diabetes (T1D). Method: 10 children aged 3-7 years (Mage= 5.88, 80% female) with T1D for at least 1 yr (2.78 ± 1.55 years) participated. For five days, participants wore blinded continuous glucose monitors (CGM) and actigraphs as objective measures of BG and PA, respectively, and parents completed daily 24 hour interviews (e.g., diet, BG monitoring). Parents also completed the Physical Activity Questionnaire (PAQ). Medical chart review was completed for the year prior to participation. Results: Glycemic control was overall good: M A1c = 7.27%± 0.69; six participants’ A1c’s \u3c 7.5 (within the 2015 American Diabetes Association (ADA) pediatric targets). Participants completed 6.32±2.15 BG checks/day and spent an average of 61% of the 5 day period above the ADA suggested BG range of 90-150 mg/dL and 18% below range. All parents reported satisfaction with their child’s PA; however, results showed kids received significantly less PA than the 60 minutes per day recommended by American Academy of Pediatrics (Average PAQ score = 2.46 ±0.61; actigraph = 19.51 moderate to vigorous min/day ±24.67). Participants consumed a mean of 1530.91± 331.08 kilo calories/day (46% carbohydrates, 18% protein, and 15% fat) generally in line with recommendations for healthy children. There was no association between moderate-vigorous PA and time spent in low BG excursions (r = 0.27, p = 0.45). Participants who engaged in PA during the morning as well as afternoon trended toward less time in overall BG excursions (ρ = 0.55, p = 0.06). Conclusions: Even young children meeting targets for A1c spend a significant portion of their day outside of the recommended BG range. Young children are more sedentary than parents perceive, and even short amounts of PA after each meal may have an impact on glycemic control for the remainder of the day

The role of setting versus treatment type in alliance within youth therapy.

Objective: Does the strength of the youth–therapist alliance differ across treatment settings or treatment type? We examined these questions in the context of youth therapy. Method: Eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with an anxiety disorder received (a) manual-based individual cognitive–behavioral therapy (ICBT) in a research setting, (b) manual-based ICBT in practice settings, or (c) nonmanualized usual care (UC) in practice settings. Coders, using the Therapy Process Observational Coding System–Alliance scale, rated 865 sessions. Youth completed the Therapeutic Alliance Scale for Children at posttreatment. Results: Youth who received ICBT in a research setting had significantly higher observer-rated alliance than youth who received either therapy delivered in practice settings. In practice settings, youth who received ICBT had significantly stronger observer-rated alliance early in treatment than youth in UC, but this difference was not observed at the end of treatment. Similarly, youth-report alliance at posttreatment was significantly higher in ICBT in the research setting, and there was no difference between ICBT and UC delivered in practice settings. Alliance differences largely held when controlling for youth characteristics; however, differences early in treatment between the ICBT groups were no longer statistically significant when controlling for anxiety severity or primary anxiety diagnosis. Conclusions: Our findings suggest that (a) the alliance may be stronger in research settings, and (b) treatment manuals do not undermine alliance. Future research is required to help pinpoint whether other youth, therapist, or setting factors contribute to the lower alliance seen in practice settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved)Psycholog

Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis

OBJECTIVE: Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis. RESEARCH DESIGN AND METHODS: One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (M = 4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child\u27s T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (M since diagnosis = 29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis. RESULTS: Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p \u3c 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress. CONCLUSIONS: Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child\u27s diagnosis may improve parents\u27 diabetes self-efficacy and ultimately support the management of their child\u27s diabetes