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1.  Erratum 
PMCID: PMC4014850
2.  Patterns and Predictors of Paternal Involvement in Early Adolescents’ Type 1 Diabetes Management Over 3 Years 
Objective To document trajectories of paternal involvement in diabetes management and examine bidirectional associations with diabetes outcomes across early adolescence. Methods 3-year prospective assessment of paternal involvement, diabetes self-management, and glycemic control among 136 youth (age 9–12 at baseline) and their mothers and fathers. Results Unconditional growth curves demonstrated decreasing amount (maternal report: F(1,128) = 14.79; paternal report: F(1,111) = 12.95, ps < 0.01) and level of contribution (maternal report: F(1,131) = 23.6, p < .01) of paternal involvement. Controlling for covariates, lower youth self-management predicted an increasing slope in fathers’ self-reported amount of involvement (b = −0.15 to −0.22, p < .05), and higher levels of fathers’ self-reported level of contribution predicted a decreasing slope in youths’ self-reported self-management (b = −0.01, p < .05). Conclusions Like mothers, fathers’ involvement declines modestly during early adolescence. Different aspects of paternal involvement influence or are influenced by youths’ self-management. Communication about ways to enhance fathers’ involvement before this transition may help prevent or reduce declining diabetes management and control common in adolescence.
PMCID: PMC3894421  PMID: 24013966
adherence; children and adolescents; fatherhood; type 1 diabetes
3.  Parent Psychological Functioning and Communication Predict Externalizing Behavior Problems After Pediatric Traumatic Brain Injury 
Objective Adolescents sustaining traumatic brain injury (TBI) show increased prevalence of behavior problems. This study investigated the associations of parent mental health, family functioning, and parent–adolescent interaction with adolescent externalizing behavior problems in the initial months after TBI, and examined whether injury severity moderated these associations. Methods 117 parent–adolescent dyads completed measures of family functioning, adolescent behavior, and parent mental health an average of 108 days post-TBI. Dyads also engaged in a 10-min video-recorded problem-solving activity coded for parent behavior and tone of interaction. Results Overall, higher ratings of effective parent communication were associated with fewer externalizing behavior problems, whereas poorer caregiver psychological functioning was associated with greater adolescent externalizing behaviors. Results failed to reveal moderating effects of TBI severity on the relationship between socio-environmental factors and behavior problems. Conclusions Interventions targeting parent communication and/or improving caregiver psychological health may ameliorate potential externalizing behavior problems after adolescent TBI.
PMCID: PMC3894422  PMID: 24065551
externalizing behavior problems; parent–adolescent interaction; protective factors; traumatic brain injury
4.  Authoritative Parenting and Cigarette Smoking Among Multiethnic Preadolescents: The Mediating Role of Anti-Tobacco Parenting Strategies 
Journal of Pediatric Psychology  2013;39(1):109-119.
Introduction Parenting has been shown to affect smoking among children in U.S. majority groups, but less is known about this association among multiethnic urban populations. Our study examines the role of parenting on smoking among a highly diverse sample. Methods Health surveys were collected from eighth graders (N =459) in 2 low-income urban schools. Structural equation models examined the direct and indirect effects of authoritative parenting on lifetime smoking. A moderated mediation analysis examined whether indirect effects of authoritative parenting vary among racial/ethnic groups. Results Authoritative controlling parenting, characterized by limit setting, was positively associated with anti-tobacco parenting. Anti-tobacco parenting was inversely associated with smoking, mediating the relationship between controlling parenting and smoking. There was no evidence that mediation was moderated by race/ethnicity. Conclusions Parent training, which focuses on setting rules and expectations, can be an important and universal element of smoking prevention programs targeted to youth in diverse communities.
PMCID: PMC3894423  PMID: 24306966
adolescents; anti-tobacco parenting; parenting; parenting style; race/ethnicity
5.  Do Depression, Self-Esteem, Body-Esteem, and Eating Attitudes Vary by BMI Among African American Adolescents? 
Journal of Pediatric Psychology  2013;38(10):1112-1120.
Objective To examine how psychosocial factors vary by body weight and gender among African-American adolescents. Methods A community sample of 235 low-income, predominantly African-American adolescents completed measures of depression, self-esteem, body-esteem, and eating attitudes. Measured weight and height were converted to body mass index (kg/m2) age and gender-adjusted z-scores. Data were analyzed using 2-factor multivariate analysis of variance. Results Obese youths had significantly worse scores on all psychosocial domains than normal weight youths, with no differences between overweight and normal weight youths. Obese youths had significantly worse scores than overweight youths on body-esteem and self-esteem. Female adolescents had significantly worse scores than males on depressed mood, body-esteem, and eating attitudes. Conclusions Among a community sample of predominantly African-American adolescents, obesity, not overweight, was associated with poor psychosocial health. Findings suggest that overweight may be perceived as normative, and that weight-related programs consider adolescents’ psychosocial functioning.
PMCID: PMC3809728  PMID: 23912163
adolescents; African-American; depression; obesity; psychosocial functioning
6.  Childhood Economic Strains in Predicting Substance Use in Emerging Adulthood: Mediation Effects of Youth Self-Control and Parenting Practices 
Journal of Pediatric Psychology  2013;38(10):1130-1143.
Objective To examine the influence of childhood economic strains on substance use in young adulthood and to assess the mediating roles of self-control as well as positive parenting during adolescence in a nationally representative longitudinal cohort. Methods The study included data from participants (n = 1,285) in the Panel Study of Income Dynamics, Child Development Supplement, and Transition to Adult. Structural equation modeling was used to evaluate the associations among risk factors during childhood and adolescence that predicted substance use in early adulthood. Results Conditions of economic strains, especially poverty, during childhood were associated with an increased likelihood of regular smoking in adulthood, which was partially mediated by poorer self-control during adolescence. Conclusions Self-control is negatively affected by economic strains and serves as a mediator between poverty and risk of regular smoking. Additional research is needed to better understand how economic strains effect the development of self-control.
PMCID: PMC3809729  PMID: 23899658
adolescents; alcohol use; drug abuse and exposure; parent stress; parenting; tobacco use
7.  Sequential Analysis of Mothers’ and Fathers’ Reassurance and Children’s Postoperative Distress 
Journal of Pediatric Psychology  2013;38(10):1121-1129.
Objective Children experience distress after surgery. Associations exist between parent reassurance (e.g., “It’s OK”) and child distress, but little is known about the causal direction of these interactions. This study examined sequential relations between mothers’ and fathers’ reassurance and children’s distress. Methods 146 families with 2- to 11-year-olds undergoing elective surgery participated. Time-event coding and time-window sequential analysis examined whether reassurance preceded or followed child distress. Secondary analyses examined the relation of child sex and parent anxiety with the reassurance/distress contingency. Results Reassurance was positively correlated with distress; however, nonverbal distress was less likely to start following reassurance and was also more likely to continue following reassurance. Mothers were more likely to reassure following boys’ verbal distress, and mothers with higher anxiety were more likely to reassure following nonverbal distress. Conclusions Whereas parental reassurance may prevent the start of child distress, it might maintain ongoing child distress.
PMCID: PMC3809730  PMID: 23962770
children; pain; parents
8.  An Examination of the Specificity of Motivation and Executive Functioning in ADHD Symptom-Clusters in Adolescence 
Journal of Pediatric Psychology  2013;38(10):1081-1090.
Objective Motivation and executive functioning are central to the etiology of attention-deficit/hyperactivity disorder (ADHD). Furthermore, it has been hypothesized that motivation should show specificity of association with ADHD-impulsivity/hyperactivity symptoms, whereas executive functioning should show specificity of association with ADHD-inattention symptoms. This study tests this specificity-hypothesis and extends previous research by conceptualizing motivation to include both reactivity to reward and punishment. Methods Executive functioning was assessed using two different laboratory measures (the Wisconsin-Card-Sort and Stop-Signal Tasks) and motivation was measured using a laboratory measure of sensitivity to reward and punishment (the Point-Scoring-Reaction-Time Task). Results Findings suggested specificity of association between executive functioning and symptoms of inattention, and between motivation and symptoms of impulsivity/hyperactivity. However, support varied across indices of executive functioning. Conclusions Results provide support for multiple component models of ADHD symptoms and extend the literature by providing a theoretically based conceptualization of motivation grounded on developmental neuroscience models of motivated behavior.
PMCID: PMC3809724  PMID: 23836192
ADHD; executive functioning; motivation; punishment; reinforcement sensitivity; reward
9.  Longitudinal Course and Risk Factors for Fatigue in Adolescents: The Mediating Role of Sleep Disturbances 
Journal of Pediatric Psychology  2013;38(10):1070-1080.
Objectives This study (1) examines fatigue over 1 year in adolescents with chronic pain (n = 61) and depressive disorders (n = 51) compared with healthy adolescents (n = 60), (2) identifies longitudinal risk factors, and (3) tests sleep disturbances as a mediator between depression and fatigue. Methods Adolescents completed questionnaires at baseline, 6, and 12 months. Mixed effects models examined associations between risk factors and fatigue; structural equation modeling assessed contemporaneous and longitudinal mediation. Results Results revealed fatigue persisted at 1 year follow-up, with adolescents in the clinical samples experiencing greater fatigue than healthy youth at all time points (ps < .001). Age, baseline depression, and baseline sleep disturbances predicted longitudinal fatigue for the total sample (ps < .05), with variation in predictors by subgroup. Sleep quality mediated the contemporaneous effects of depression on fatigue in the clinical samples (ps < .05). Conclusions Findings underscore the longitudinal course of fatigue and suggest that improving sleep disturbances may reduce fatigue in clinical samples.
PMCID: PMC3809725  PMID: 23860262
adolescents; depression; fatigue; recurrent and chronic pain; sleep
10.  Perception of Pulmonary Function and Asthma Control: The Differential Role of Child Versus Caregiver Anxiety and Depression* 
Journal of Pediatric Psychology  2013;38(10):1091-1100.
Objective To examine child and caregiver anxiety and depression as predictors of children’s perception of pulmonary function, quick-relief medication use, and pulmonary function. Method 97 children with asthma, ages 7 to 11 years old, reported their anxiety and depressive symptoms and completed spirometry. Caregivers completed a psychiatric interview. Children’s predictions of their peak expiratory flow were compared with actual values across 6 weeks. Quick-relief medication use was assessed by Dosers. Results Children’s anxiety symptoms were associated with over-perception of respiratory compromise and greater quick-relief medication use. Children’s depressive symptoms were associated with greater quick-relief medication use, but not perception of pulmonary function. Children of caregivers with an anxiety or depressive disorder had lower pulmonary function than children of caregivers without anxiety or depression. Conclusions Child anxiety was associated with a subjective pattern of over-perception. Caregiver anxiety and depression were risk factors for lower lung function assessed by objective measurement.
PMCID: PMC3809726  PMID: 23873703
anxiety; asthma; depression; mental health
11.  Preventing Posttraumatic Stress Following Pediatric Injury: A Randomized Controlled Trial of a Web-Based Psycho-Educational Intervention for Parents 
Journal of Pediatric Psychology  2013;38(10):1101-1111.
Objective The study objective is to evaluate the feasibility and efficacy of a web-based intervention for parents ( [ATI]) in promoting emotional recovery following pediatric injury. Methods 100 children with injuries requiring medical attention and their parents were randomly assigned to the intervention or usual care. Efficacy outcomes included parent knowledge and child and parent posttraumatic stress symptoms (PTSS). Results All parents in the intervention group completed the intervention (directed use of ATI) in the hospital. 56% reported using ATI online post-discharge, and 100% of these parents found it helpful. Parent knowledge increased immediately post-intervention, but there was no significant intervention impact on parent knowledge or PTSS at a 6-week follow-up. Relationships between knowledge and PTSS were identified. Conclusions Brief web-based interventions introduced during child hospitalization are a feasible strategy to reach many parents following pediatric injury. Preventing psychological symptoms may require more than parental education alone.
PMCID: PMC3809727  PMID: 23912164
child injury; emotional recovery; parents; posttraumatic stress; PTSD
12.  Developmentally and Culturally Appropriate Screening in Primary Care: Development of the Behavioral Health Checklist 
Journal of Pediatric Psychology  2013;38(10):1155-1164.
Objective To evaluate the construct validity of the Behavioral Health Checklist (BHCL) for children aged from 4 to 12 years from diverse backgrounds. Method The parents of 4–12-year-old children completed the BHCL in urban and suburban primary care practices affiliated with a tertiary-care children’s hospital. Across practices, 1,702 were eligible and 1,406 (82.6%) provided consent. Children of participating parents were primarily non-Hispanic black/African American and white/Caucasian from low- to middle-income groups. Confirmatory factor analyses examined model fit for the total sample and subsamples defined by demographic characteristics. Results The findings supported the hypothesized 3-factor structure: Internalizing Problems, Externalizing Problems, and Inattention/Hyperactivity. The model demonstrated adequate to good fit across age-groups, gender, races, income groups, and suburban versus urban practices. Conclusion The findings provide strong evidence of the construct validity, developmental appropriateness, and cultural sensitivity of the BHCL when used for screening in primary care.
PMCID: PMC3888156  PMID: 23978505
behavior problems; mental health; primary care
13.  Commentary: Pediatric Obesity: Systems Science Strategies for Prevention 
Journal of Pediatric Psychology  2013;38(9):1044-1050.
Objectives Pediatric obesity is a major public health problem that undermines the physical and mental health of children and increases their risk for adult obesity and other chronic illnesses. Although health care providers, including pediatric psychologists, have implemented prevention programs, effects have been minimal, with no solid evidence of sustainable programs. Methods A systems science framework that incorporates the multiple interacting factors that influence pediatric obesity may be useful in guiding prevention. Results The National Prevention Strategy provides recommendations that can be incorporated into systems science designs, including (1) Healthy and Safe Environments, (2) Clinical and Community Preventive Services, (3) Empowering People, and (4) Elimination of Health Disparities. In addition, our recommendation is that future obesity prevention programs target early in life (pre-pregnancy through toddlerhood) and use multilevel multidisciplinary designs. Conclusions The benefits of preventing pediatric obesity extend from the health and well-being of individual children to the economic security of the nation.
PMCID: PMC3888301  PMID: 24013965
14.  Treating Rural Pediatric Obesity Through Telemedicine: Outcomes From a Small Randomized Controlled Trial 
Journal of Pediatric Psychology  2013;38(9):932-943.
Objective The objective of the current study was to examine the effectiveness of a multidisciplinary weekly family-based behavioral group delivered via telemedicine to rural areas, compared with a standard physician visit intervention. Methods A randomized controlled trial was conducted with 58 rural children and their families comparing a family-based behavioral intervention delivered via telemedicine to a structured physician visit condition. Outcome measures included child body mass index z-score (BMIz), 24-hr dietary recalls, accelerometer data, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale, and feasibility and fidelity. Results Child BMIz outcomes were not statistically different between the 2 groups (F = 0.023, p = .881). Improvements in BMIz, nutrition, and physical activity were seen for both groups. Conclusions Both telemedicine and structured physician visit may be feasible and acceptable methods of delivering pediatric obesity treatment to rural children.
PMCID: PMC3785218  PMID: 23428652
obesity; randomized controlled trial; weight management
15.  Project SHINE: Effects of Parent–Adolescent Communication on Sedentary Behavior in African American Adolescents 
Journal of Pediatric Psychology  2013;38(9):997-1009.
Objective This study examined parenting variables (communication, monitoring) as moderators of a family-based intervention for reducing sedentary behavior (SB) in African American adolescents. As a secondary aim, a similar model was tested using adolescent weight status as the outcome. Methods African American adolescents (n = 73; 12.45 ± 1.45 years; 60% girls; 63% overweight/obese) and caregivers were randomized to a 6-week interactive, parent-based intervention or general health condition. Parent–adolescent communication and monitoring of health behaviors were self-reported by parents. Adolescent SB was self-reported by youth. Results There was a significant intervention by communication interaction, such that intervention families with more positive communication showed lower adolescent SB than those with less positive communication or those in the comparison condition. No effects were found for monitoring on SB or for the model with weight status as the outcome. Conclusions Parent–adolescent communication may be an effective component to integrate into health promotion programs for African American adolescents.
PMCID: PMC3785219  PMID: 23685450
adolescents; African American; family-based intervention; parent–adolescent communication;  sedentary behavior
16.  Treatment of Adolescent Obesity Comparing Self-Guided and Group Lifestyle Modification Programs: A Potential Model for Primary Care 
Journal of Pediatric Psychology  2013;38(9):978-986.
Lifestyle modification programs (LMP) for weight loss in adolescents with obesity are effective but not available. Primary care may be a setting for reaching more adolescents. Two models of LMP for use in primary care were examined. Adolescents and caregivers enrolled in a 1-year randomized trial comparing Group LMP with Self-Guided LMP. All participants (N = 169) received the same treatment recommendations and met with a health coach six times in clinic. Group LMP participants had an additional 17 group sessions; those in Self-Guided LMP followed the remainder of the program at home with parental support. The primary outcome was percentage change in initial body mass index. The mean (SE) 1.31% (0.95%) reduction in Group LMP did not differ significantly from the 1.17% (0.99%) decrease in the Self-Guided LMP (p = 0.92). Both treatments were significantly effective in reducing body mass index. Given its brevity, the Self-Guided LMP offers an innovative approach for primary care.
PMCID: PMC3785220  PMID: 23750019
adolescents; obesity; primary care; weight management
17.  A Randomized Clinical Trial Comparing Delivery of Behavioral Pediatric Obesity Treatment Using Standard and Enhanced Motivational Approaches 
Journal of Pediatric Psychology  2013;38(9):954-964.
Objective To examine the efficacy of an adjunct motivational and autonomy-enhancing intervention (self-directed) for behavioral family-based pediatric obesity relative to the standard prescription of uniform behavioral skills use and interventionist goal assignment (prescribed). Methods In this randomized clinical trial, 72 overweight/obese children and their parents/caregivers were assigned to either self-directed or prescribed intervention for 20 weeks, with approaches diverging after week 5. Anthropometric measurements from child and participating parent at baseline, posttreatment, and 3-month, 6-month, 1-year, and 2-year follow-ups were evaluated for change (n = 59 in follow-up analyses). Results The approaches demonstrated similar child body mass index (BMI) z-score and parent BMI change from baseline to posttreatment and throughout follow-up, with child and parent weight status lower than baseline at 2 years after treatment cessation. Conclusions An adjunct motivational and autonomy-enhancing approach to behavioral family-based pediatric obesity treatment is a viable alternative to the standard intervention approach.
PMCID: PMC3785221  PMID: 23902797
health promotion and prevention; obesity; weight management
18.  Adapting Interpersonal Psychotherapy for the Prevention of Excessive Weight Gain in Rural African American Girls 
Journal of Pediatric Psychology  2013;38(9):965-977.
Objective To obtain focus group data regarding the perspectives of rural African American (AA) girls, parents/guardians, and community leaders on obesity, loss of control (LOC) eating, relationships, and interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). Methods 7 focus groups (N = 50 participants) were moderated and the transcripts analyzed by Westat researchers using widely accepted methods of qualitative and thematic analysis. A session was held with experts in health disparities to elucidate themes. Results Participants understood LOC eating; however, they had culturally specific perceptions including usage of alternative terms. Relationships were highly valued, specifically those between mothers and daughters. IPT-WG program components generally resonated with participants, although modifications were recommended to respect parental roles. Experts interpreted focus group themes and discussed potential barriers and solutions to recruitment and participation. Conclusion Findings suggest that adapting IPT-WG may be acceptable to rural AA families. This research is the first step in developing a sustainable excessive weight gain and binge eating disorder prevention program for rural AA adolescents.
PMCID: PMC3859230  PMID: 23678135
African American; community-based participatory research; interpersonal psychotherapy; loss of control eating; obesity; prevention
19.  Executive Functioning Skills in Long-Term Users of Cochlear Implants: A Case Control Study 
Journal of Pediatric Psychology  2013;38(8):902-914.
Objective To investigate differences in executive functioning between deaf children with cochlear implants (CIs) and normal-hearing (NH) peers. The cognitive effects of auditory deprivation in childhood may extend beyond speech–language skills to more domain-general areas including executive functioning. Methods Executive functioning skills in a sample of 53 prelingually deaf children, adolescents, and young adults who received CIs prior to age 7 years and who had used their CIs for ≥7 years were compared with age- and nonverbal IQ-matched NH peers and with scale norms. Results Despite having above average nonverbal IQ, the CI sample scored lower than the NH sample and test norms on several measures of short-term/working memory, fluency–speed, and inhibition–concentration. Executive functioning was unrelated to most demographic and hearing history characteristics. Conclusions Prelingual deafness and long-term use of CIs was associated with increased risk of weaknesses in executive functioning.
PMCID: PMC3747713  PMID: 23699747
cognitive assessment; deafness and hearing loss; neuropsychology
20.  Relationship Satisfaction Among Mothers of Children With Congenital Heart Defects: A Prospective Case-Cohort Study 
Journal of Pediatric Psychology  2013;38(8):915-926.
Objective To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. Methods Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. Results The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. Conclusions Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfaction.
PMCID: PMC3747714  PMID: 23792348
chronic illness in children; congenital heart defects; motherhood; partnership; relationship stability
21.  Development and Reliability of a Correction Factor for Family-Reported Medication Adherence: Pediatric Inflammatory Bowel Disease as an Exemplar 
Journal of Pediatric Psychology  2013;38(8):893-901.
Objectives To examine the issue of accurate adherence assessment and illustrate methodologies for correcting parent-reported medication adherence. Methods 40 children with inflammatory bowel disease provided medication adherence data using electronic monitoring. Parents provided subjective reports of medication adherence. Receiver operating characteristic analyses were used to examine the detection of non-adherence at several adherence cut-points. 2 methods for empirically deriving a correction factor for subjectively reported adherence were applied. Results Although parent-report and EM adherence were significantly correlated, parent-reported adherence was significantly higher than EM adherence. A 90% cut-point provided the highest sensitivity and specificity. Both correction factors reliably adjusted parent-reported adherence based on EM adherence. Conclusions Application of an empirically derived correction factor for parent-reported adherence using methodologies, such as those illustrated in the current study, could yield more accurate adherence assessment. Obtaining more accurate adherence assessments based on parent-report will have implications for self-management interventions, clinician prescribing behavior, and medication safety.
PMCID: PMC3859234  PMID: 23804406
compliance; measurement; medication-taking; nonadherence; self-management
22.  Discrepancies in Mother and Child Perceptions of Spina Bifida Medical Responsibilities During the Transition to Adolescence: Associations With Family Conflict and Medical Adherence 
Journal of Pediatric Psychology  2013;38(8):859-870.
Objective This study investigated mother–child discrepancies over perceptions of who is responsible for spina bifida (SB) medical tasks in relation to family conflict and medical adherence. Method 140 youth with SB and their mothers completed questionnaires regarding who is responsible for specific SB medical tasks, family conflict, and medical adherence. An observational measure was also used to assess family conflict. Results Although children viewed themselves as more responsible for medical management than mothers did, mother–child discrepancies were not associated with family conflict or medical adherence. Interaction effects revealed that adherence was better when family conflict was low and when parents were responsible for medical tasks. Conclusions Parental involvement in SB medical care is essential for optimal medical adherence during adolescence. The presence of family conflict also plays an influential role on SB medical adherence. Future research should evaluate the relations between discrepancies, family conflict, and medical adherence across time.
PMCID: PMC3895972  PMID: 23843631
adherence; adolescents; assessment; family functioning; spina bifida
23.  The Relationships Between Fatigue, Quality of Life, and Family Impact Among Children With Special Health Care Needs 
Journal of Pediatric Psychology  2013;38(7):722-731.
Objective To examine the relationships among pediatric fatigue, health-related quality of life (HRQOL), and family impact among children with special health care needs (CSHCNs), specifically whether HRQOL mediates the influence of fatigue on family impact. Methods 266 caregivers of CSHCNs were studied. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Pediatric Quality of Life Inventory Generic Scale, and Impact on Family Scale were used to measure fatigue, HRQOL, and family impact, respectively. Linear regressions were used to analyze the designated relationships; path analyses were performed to quantify the mediating effects of HRQOL on fatigue–family impact relationship. Results Although greater fatigue was associated with family impact (p < .05), the association was not significant after accounting for HRQOL. Path analyses indicated the direct effect of fatigue on family impact was not significant (p > .05), whereas physical and emotional functioning significantly mediated the fatigue–family impact relationship (p < .001). Conclusion Fatigue is related to family impact among CSHCNs, acting through the impairment in HRQOL.
PMCID: PMC3721186  PMID: 23584707
children with special health care needs; chronic condition; family impact; fatigue; quality of life
24.  Mother–Child Communication and Maternal Depressive Symptoms in Families of Children With Cancer: Integrating Macro and Micro Levels of Analysis 
Journal of Pediatric Psychology  2013;38(7):732-743.
Objectives This study examines associations between maternal depressive symptoms and macro- and micro-level aspects of mothers’ communication about their children’s cancer. Methods Mothers reported depressive symptoms after diagnosis or relapse (child mean age = 10.4 years; 53% male). Mother–child dyads (N = 94) were subsequently observed discussing the child’s cancer and maternal communication was coded. Results Macro-level indicators (positive and negative communication) were associated with certain micro-level indicators of communication (topic maintenance, reflections, reframes, and imperatives). Higher depressive symptoms predicted lower positive communication and higher negative communication. Maternal reflections and imperatives predicted positive communication, and topic maintenance and reframes predicted negative communication, beyond child age, family income, and depressive symptoms. Conclusions Findings suggest concrete targets for improving communication in families after diagnosis or relapse.
PMCID: PMC3721187  PMID: 23616622
cancer and oncology; mother–child communication
25.  The Association Between Weight Loss in Caregivers and Adolescents in a Treatment Trial of Adolescents With Obesity 
Journal of Pediatric Psychology  2013;38(7):766-774.
Objective The relationship between weight change in caregivers and their adolescents was evaluated following a randomized trial of lifestyle modification for adolescents, which included either a conventional diet or meal replacements. Methods Adolescents (N = 113) had an M ± SD age of 15.0 ± 1.3 years (62% African American; 26% Caucasian, 12% other; 81% female) and body mass index of 37.1 ± 5.1 kg/m2. Results Mixed effects models yielded a significant association between percentage change in body mass index of caregivers and adolescents from baseline to months 4 and 12 (p = .01). When caregivers lost above the median (−1.67%) at month 4, their adolescents achieved a significantly greater loss at month 12 (−9.1 ± 1.3%) compared with adolescents whose caregivers lost less than the median (−4.3 ± 1.3%) (p = .003). Conclusion Engaging caregivers in their own weight loss efforts during adolescent weight loss treatment may improve adolescent weight loss.
PMCID: PMC3721188  PMID: 23629145
adolescent; behavioral intervention; caregiver; weight loss

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