Chronic pain and emotional distress in children and adolescents.

Pediatric chronic pain continues to be relatively underinvestigated and undertreated. The objective of the present cross-sectional study was to investigate the emotional distress hypothesized to be concurrently associated with the chronic pain experience in children and adolescents. One hundred and sixty children and adolescents with chronic pain and their parents completed standardized assessment instruments measuring pain intensity, depressive symptoms, state anxiety, trait anxiety, general self-esteem, and internalizing and externalizing behavior problems.

Assessing chronic musculoskeletal pain associated with rheumatic disease: further validation of the pediatric pain questionnaire.

Evaluated the validity, stability, and clinical utility of the Pediatric Pain Questionnaire (PPQ), a comprehensive, multidimensional instrument for assessing childhood pain. Previous studies demonstrated adequate psychometric properties of the PPQ using small samples. Results of the current study, using a large sample (N = 100) of children and adolescents with chronic pain associated with rheumatic disease, were consistent with initial validation studies.

Family functioning predictors of adjustment in children with newly diagnosed cancer: a prospective analysis.

Theoretically-driven investigations on the potentially modifiable predictors of individual differences among newly-diagnosed pediatric cancer patients may facilitate the identification of children at risk for adjustment problems. Within a risk and resistance conceptual model, family functioning was investigated concurrently and prospectively as a predictor of adjustment in newly-diagnosed pediatric cancer patients at Time 1 (within 1 month after diagnosis), Time 2 (6 months postdiagnosis), and Time 3 (9 months postdiagnosis). The family relationship dimensions of cohesion and expressiveness most consistently predicted the psychological and social adjustment of children with newly-diagnosed cancer over a 9-month period after initial diagnosis.

Perceived physical appearance and adjustment of children with newly diagnosed cancer: a path analytic model.

More intensive medical treatment protocols have been initiated with the goal of improving survival of pediatric cancer patients. Evaluation of the adjustment of this cohort of children with newly diagnosed cancer being treated with these modern regimens is essential in order to enhance quality of life. Children with cancer who experience disease and treatment-related changes in physical appearance are hypothesized to be at greater risk for psychological and social adjustment problems given society's attitudes toward visible physical differences.

Perceived social support and adjustment of children with newly diagnosed cancer.

The negative impact on psychologic adjustment from the stress of living with newly diagnosed cancer is hypothesized to be affected by perceived social support. Thirty children with newly diagnosed cancer completed standardized assessment instruments measuring depressive symptoms, state anxiety, trait anxiety, social anxiety, general self-esteem, and perceived social support from classmates, parents, teachers, and friends. Their parents completed a standardized assessment instrument measuring internalizing and externalizing behavior problems.

The impact of social skills training on the adjustment of children with newly diagnosed cancer.

Randomized 64 children ages 5 to 13 years with newly diagnosed cancer to either a Social Skills Training experimental treatment group or a School Reintegration standard treatment group. Children who received explicit training in social skills reported higher perceived classmate and teacher social support at the 9-month follow-up in comparison to pretreatment levels, while parents reported a decrease in internalizing and externalizing behavior problems and an increase in school competence. Methodological improvements for Phase III clinical trials are addressed.

Social support and social cognitive problem-solving in children with newly diagnosed cancer.

Children newly diagnosed with cancer have been documented to be at increased risk for difficulties in their return to school and ongoing positive social experiences. This article reviews the critical role of social support in helping children adjust to their illness and treatment. Social skills training for newly diagnosed children is presented as an important intervention strategy for increasing positive social interactions and overall psychosocial adjustment.

Effects of parental adjustment on the adaptation of children with congenital or acquired limb deficiencies.

Maternal and paternal depression, anxiety, and marital discord were investigated as predictors of depression, anxiety, and self-esteem in 54 children with congenital or acquired limb deficiencies. Higher paternal depression predicted higher child depression and higher anxiety. Higher paternal anxiety predicted higher child depression and anxiety and lower self-esteem.

Teacher, parent, and child evaluative ratings of a school reintegration intervention for children with newly diagnosed cancer.

The disruption of school participation and accompanying social experiences because of cancer and its treatment has been related to major problems in adaptation to the disease. For the child with cancer, continuation of his/her social and academic activities provides an important opportunity to normalize as much as possible a very difficult experience. The present study reports on the children's, parents', and teachers' subjective evaluations of the benefits of a comprehensive school reintegration intervention.

Cognitive-behavioral pain management in children with juvenile rheumatoid arthritis.

Decreasing chronic joint pain is a major goal in the management of juvenile rheumatoid arthritis. Cognitive-behavioral self-regulatory techniques were taught to children with juvenile rheumatoid arthritis to reduce musculoskeletal pain intensity and to facilitate better adaptive functioning. Subjects were 13 children between the ages of 4.

Evaluation and management of pain in children with juvenile rheumatoid arthritis.

The systematic evaluation and management of chronic and recurrent pain in children with juvenile rheumatoid arthritis (JRA) is only in the beginning stages of empirical development. While recent advances have been made in the assessment of pain secondary to JRA, very little clinical research has been targeted toward pain management. Development of reliable and valid pediatric pain measures is the first step in advocating controlled clinical trials with pain as an essential outcome variable.

Psychological adjustment and perceived social support in children with congenital/acquired limb deficiencies.

The negative impact on psychological adjustment from the chronic strain of living with limb deficiencies appears to be mediated by perceived social support. A multifactorial investigation was conducted to identify empirically psychological adjustment correlates of perceived social support in 49 children with congenital/acquired limb deficiencies. A multiplicity of adjustment factors (depression, trait anxiety, self-esteem) was variously related to perceived parent, teacher, classmate, and friend social support.

Screening for behavioral and emotional problems in children and adolescents with congenital or acquired limb deficiencies.

Children with chronic physical handicaps have been found to be at risk for psychological and social adjustment problems. Accurately identifying in a timely manner those physically handicapped children who are functioning at clinically significant levels of maladjustment may aid in preventing further psychosocial morbidity. The parents of 111 children and adolescents with congenital/acquired limb deficiencies completed the Child Behavior Checklist as a screening instrument to facilitate the identification of behavioral and emotional problems and social incompetence.

Effects of stress, social support, and self-esteem on depression in children with limb deficiencies.

Limb deficiencies in children are the result of trauma, disease, or congenital causes. The potentially negative impact on psychologic adjustment from the chronic strain of living with limb deficiencies appears to be mediated by perceived social support (interpersonal protective factor), microstressors and daily hassles (socioenvironmental risk factor), and self-esteem (intrapersonal protective factor). These risk and protective factors were simultaneously investigated as potential predictors of depressive symptomatology in 54 children with congenital or acquired limb deficiencies.

Evaluation and management of pain in children with rheumatic diseases.

The evaluation and management of pain in children with rheumatic diseases are still in the early stages of empirical development. Nevertheless, with the advent of the PPQ, systematic research efforts are now underway to develop the reliability and validity of the PPQ's measurement characteristics for pediatric rheumatic diseases. With these developments, the inclusion of pediatric pain measurement as an essential outcome variable in controlled clinical trials should be advocated.

Correlates of perceived physical appearance in children with congenital/acquired limb deficiencies.

Social support, daily hassles, marital discord, competence/adequacy, and psychological adjustment were investigated as hypothesized correlates of perceived physical appearance in 51 children with congenital or acquired limb deficiencies. Higher classmate, parent, and teacher social support were statistically predictive of higher perceived physical appearance. Higher daily hassles and marital discord were statistically predictive of lower perceived physical appearance.

Cognitive functioning in long-term survivors of childhood leukemia: a prospective analysis.

Treatment-related cognitive impairments have been reported for survivors of childhood leukemia following prophylactic central nervous system (CNS) treatment with 2400 cGy craniospinal irradiation and intrathecal chemotherapy. The present study was designed to prospectively evaluate cognitive functioning of 24 children prior to CNS prophylaxis of 1800 cGy of craniospinal irradiation and intrathecal drugs, and at intervals of 1 and 4-5 years. At diagnosis, prior to CNS treatment, all 24 subjects performed in the average range of intelligence, as measured by the Wechsler Intelligence Scales.

Stress, social support, and depressive symptomatology in children with congenital/acquired limb deficiencies.

Ongoing chronic strain of living with limb deficiencies and normal daily hassles may interact to produce a negative impact on adjustment. Degree of limb loss, daily hassles/microstressors, and classmate, parent, teacher, and friend social support were investigated as predictors of depressive symptomatology in 27 children with congenital/acquired limb deficiencies. Hierarchical multiple regression analyses were utilized to test the main effects and buffering interactions effects models of the stress-social support-depressive symptomatology relationship.

The social environment and the adaptation of mothers of physically handicapped children.

Evaluated relationships between social environmental characteristics and adaptation in 50 mothers of congenitally physically handicapped 6- to 11-year-old children. Mothers reported on utilitarian resources, child adjustment, psychosocial family resources, service utilization, and three dimensions of adaptation. Analyses of the concurrent correlational design indicated significant proportions of the variance in mental and social functioning were explained by features of the social environment.

Family functioning, temperament, and psychologic adaptation in children with congenital or acquired limb deficiencies.

Family functioning and child temperament variables were investigated as predictors of psychologic and social adaptation in 42 children with congenital or acquired limb deficiencies. Higher psychologic and social adaptation were seen when there was more family cohesion and moral-religious emphasis and organization, in combination with less family conflict. With regard to child temperament, more emotionality predicted greater internalizing and externalizing behavior problems and less social competence.

Family resources as resistance factors for psychological maladjustment in chronically ill and handicapped children.

The hypothesis that their psychological adjustment is related in part to resources present in their families was investigated in 153 children, age 4-16, who had one of five chronic physical disorders: juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy. Their mothers completed standardized psychometric instruments to measure specific dimensions of family psychological and utilitarian resources and of child adjustment. Variation in children's psychological adjustment was related both to their psychological and utilitarian family resources.