The Outpatient Developmental Services Project: integration of pediatric psychology with primary medical care for children infected with HIV.
(9/544)
OBJECTIVE: To present a model in which pediatric psychology services are programmatically integrated into the primary care of children seen in a special immunology program. The program centers around serial neurodevelopmental/neuropsychological evaluation of children infected with HIV. METHOD: We describe the population served and the particular services provided, with specific focus on how the program was developed. We include a discussion of the barriers to service provision that have been encountered and the strategies employed to overcome these challenges. CONCLUSIONS: This approach, while not ideal, serves as a good example of how pediatric psychology can merge with primary medical care to maximize the benefits of both specialties for a patient population that is underserved in many respects. (+info)
Predictors of unintentional injuries to school-age children seen in pediatric primary care.
(10/544)
OBJECTIVE: To identify predictors of unintentional injury to school-age children seen in pediatric primary care. METHODS: Members of a managed health care system (295 children ages 5-11 years and their mothers) participated. We used Time 1 measures of child, maternal, and family functioning and health care utilization to predict rates of unintentional child injury for the following year. Multiple regression analyses were performed to identify variables contributing to prospective injury rates. RESULTS: The final regression model included eight Time 1 variables and accounted for 21% of the variance in Time 2 injury rates. Significant predictors of increased injury liability were younger child age, more children at home, child behavior problems, child social competence, three indices of reduced child health, and maternal anxiety. CONCLUSIONS: We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury. (+info)
Commentary: collaboration in pediatric primary care: a pediatrician's view.
(11/544)
Although neither pediatricians nor psychologists can provide alone for the vast needs of children and families in our increasingly complex society, these needs can be met through effective collaboration. An ideal model for collaboration would exist if pediatricians and psychologists worked together in practice teams, for which developmental-behavioral pediatricians might serve as consultants. Together, these professionals could take responsibility for professional education, expanded clinical care, liaisons with schools and other community-based resources for children and families, and research that addressed questions about the development, coping, and correction of children's and families' difficulties. (+info)
Empirically supported treatments in pediatric psychology: bedtime refusal and night wakings in young children.
(12/544)
OBJECTIVE: To review the literature for empirically supported treatments for bedtime refusal and night wakings in young children. METHODS: An extensive review of the literature resulted in the inclusion of 41 studies that were evaluated according to the criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures (1995). RESULTS: Evidence exists indicating that extinction and parent education on the prevention of sleep problems can be considered well-established treatments. Furthermore, graduated extinction and scheduled awakenings are probably efficacious treatments, with positive routines a promising intervention. CONCLUSIONS: A discussion of effectiveness, treatment feasibility, cost-effectiveness, and methodological limitations of the studies is provided. Recommendations for future directions for research in the treatment of these two common sleep disorders are presented. (+info)
Condition severity and psychosocial functioning in pre-adolescents with spina bifida: disentangling proximal functional status and distal adjustment outcomes.
(13/544)
OBJECTIVE: To examine relations between condition severity and psychosocial functioning in 70 8- and 9-year-old pre-adolescents with spina bifida by testing several direct, indirect, and mediated effects models for proximal functional status and distal adjustment outcomes. METHODS: Proximal functional status outcomes (e.g., degree of involvement in activities, scholastic competence, athletic competence, attentional problems) and distal adjustment outcomes (e.g., behavior problems, social competence) were assessed with mother, father, and teacher report. Severity variables included spinal lesion level, spina bifida classification, shunt status, ambulation status, number of shunt surgeries, and two severity composites. RESULTS: Condition severity was associated with the proximal functional status outcomes across parent and teacher report. In contrast, no significant relationships were found between the severity parameters and distal adjustment outcomes. Findings supported a proximal effects model of condition severity as well as an indirect effects model (e.g., presence of a shunt-->less scholastic competence-->less social competence) and were consistent with recent theoretical formulations (e.g., Wallander & Varni, 1995). CONCLUSIONS: Disentangling proximal functional status outcomes and distal adjustment outcomes is critical in studies of condition severity and psychosocial functioning. We discuss clinical implications. (+info)
Bereaved children.
(14/544)
OBJECTIVE: To describe the unique aspects of childhood grief. To provide a framework for family physicians to use in assisting children to grieve. QUALITY OF EVIDENCE: A MEDLINE search from 1966 to 1999 using the key words children, childhood, grief, mourning, and bereavement revealed mainly expert opinion articles, some non-randomized observational studies, and retrospective case-control studies. MAIN MESSAGE: Although children are influenced by similar factors and need to work through the same tasks of grief as adults, their unique psychological defences and evolving cognitive and emotional development make their grieving different from adults'. Understanding these unique childhood features will allow family physicians to more effectively help children through the tasks of acknowledging a death, working through the pain of that death, and accommodating it. CONCLUSIONS: With a framework for grief counseling that incorporates unique features of children's mourning, family physicians will be in a better position to assist their young bereaved patients. (+info)
Children's perceptions of peers with somatic symptoms: the impact of gender, stress, and illness.
(15/544)
OBJECTIVE: To investigate how illness characteristics influence children's responses to ill peers. METHODS: A sample of 363 4th and 5th graders responded to a vignette describing a peer with abdominal pain. In a 2 x 2 x 2 x 2 design, conditions varied by (a) evidence for organic disease, (b) presence of stress, (c) sex of vignette character, and (d) sex of respondent. Children rated symptom severity, liking for the peer, and whether the peer should be excused from normal responsibilities. RESULTS: Same sex preferences significantly influenced children's liking for a peer. Children viewed symptoms with an organic etiology as more severe than those without one. Under certain conditions, symptom severity judgments mediated the relation between the presence of organic disease and (a) liking and (b) granting relief from responsibility. The presence of stress had little effect on ratings of symptom severity, liking, or relief from responsibility. CONCLUSIONS: Gender and evidence of organic disease influence children's perceptions of and responses to symptomatic peers. (+info)
Children's attitudes and behavioral intentions toward a peer presented as obese: does a medical explanation for the obesity make a difference?
(16/544)
OBJECTIVE: To examine the effect of information on children's attitudes and behavioral intentions toward a peer presented as obese. METHODS: Children (N = 184) were randomly assigned to observe a video of a boy or girl in one of three conditions: average-weight, obese, obese with medical information explaining the obesity. They rated stereotypical attitudes on the Adjective Checklist and behavioral intentions on the Shared Activities Questionnaire (SAQ-B). RESULTS: Ratings were generally more favorable for the average-weight than for the obese condition. However, provision of medical information had a positive effect on attitudes toward the obese peer only for younger children and a negative effect on willingness of older children to share academic activities with the peer. Boys and girls showed more positive behavioral intentions toward the same-sex target child regardless of obesity condition. CONCLUSIONS: Information explaining obesity has a minimal positive effect on children's attitudes and behavioral intentions toward a peer presented as obese. (+info)