Ahna L.H. Pai

A meta-analysis of the neuropsychological sequelae of chemotherapy-only treatment for pediatric acute lymphoblastic leukemia

Mixed findings on the neuropsychological sequelae of chemotherapy‐only treatment for pediatric acute lymphoblastic leukemia (ALL), without radiation, indicate the need for a comprehensive meta‐analytic review. The purpose of the current study was to conduct a meta‐analysis assessing neuropsychological and academic functioning differences between children with ALL treated solely with chemotherapy and comparison groups.

Treatment Adherence in Adolescents and Young Adults Affected by Chronic Illness During the Health Care Transition From Pediatric to Adult Health Care: A Literature Review

As increasing numbers of children survive into adulthood more adolescents and young adults are negotiating the process of transitioning from pediatric- to adult-centered care. During this health care transition (HCT), significant declines in treatment adherence have been observed. Therefore, the purpose of this review is to examine the rates of, factors that influence, and the impact of non-adherence on health outcomes during the HCT, as well as interventions that promote adherence during the HCT. Age, psychological functioning, and insurance status are related to non-adherence during the HCT period. Systematic measurement of adherence in studies examining the HCT is needed.

Systematic Review and Meta-Analysis of Psychological Interventions to Promote Treatment Adherence in Children, Adolescents, and Young Adults With Chronic Illness

OBJECTIVE This meta-analysis examined the effectiveness of recent adherence-promoting interventions for youth with chronic health conditions. METHODS Peer-reviewed randomized controlled trials of adherence-promoting interventions for youth with a chronic illness published between 2007 and 2013 (n = 23) were reviewed. Intervention delivery (in-person vs. technology-based) and outcome measurement (e.g., self-report) were examined as potential moderators of treatment effects. RESULTS Mean effect sizes were small at posttreatment (d = 0.20, 95% confidence interval (CI): 0.08, 0.31, n = 23) and follow-up (d = 0.29, 95% CI: 0.15, 0.43, n = 9). Intervention delivery and outcome measurement did not account for variation in treatment effects (p > .05). CONCLUSIONS The small treatment effects of recent adherence-promoting intervention (APIs) reflect the methodological limitations of the included studies and the need to reexamine the delivery and mechanisms of adherence-promoting interventions.

Introduction to the Special Section: Health Care Transitions of Adolescents and Young Adults with Pediatric Chronic Conditions

Over 90% of children with pediatric chronic conditions will survive to adulthood. As a result, an increasing number of adolescents and young adults (A/YA) with a chronic health condition will undergo a health care transition (HCT); the purposeful, planned movement from child-centered to adult-oriented health care systems including primary and subspecialty care (Blum et al., 1993). The purpose of transition is to effectively engage the A/YA in the adult health care system so that they receive developmentally and medically appropriate care to facilitate optimal health outcomes and quality of life (Rosen, Blum, Britto, Sawyer, & Siegel, 2003). The term transfer, often confused with transition, refers to the actual act of moving to a new health care setting, provider, or both (Betz & Redcay, 2003; Betz & Telfair, 2007). The transition to adult-based medical care typically occurs during a vulnerable developmental period and is accompanied by multiple barriers (e.g., difficulty establishing medical care with an adult care provider, difficulties negotiating the unfamiliar adult health care system, lack of communication between pediatric and adult providers, and differences between pediatric and adult approaches to care). Therefore, the HCT presents a number of challenges that patients, families, providers, and the larger health care system is ill equipped to handle. In response, numerous consensus statements have called for multi-disciplinary action to address this critical issue (American Academy of Pediatrics, 2002; Blum et al., 1993; DHHS, 2000). However, theoretical frameworks to guide research and practice in HCT remain underdeveloped and empirical data regarding HCT is extremely limited. This special section of the Journal of Pediatric Psychology is presented in response to the changing composition and needs of the pediatric populations that the journal serves. Traditionally, this interdisciplinary journal has disseminated science that applies psychological principles to optimize long-term medical and psychological outcomes in children, adolescents and their families. As pediatric populations age, research focusing on the needs of A/YA with special health care needs is increasingly relevant to patients, families, clinicians, researchers, policy makers, and other consumers of the journal. Therefore, it is incumbent for the Journal of Pediatric Psychology to address the needs of A/YA with special health care needs. The intent of this special section is to highlight the need for and to encourage future research in HCT and to formally identify HCT as an area of importance for the Journal of Pediatric Psychology.

Treatment Adherence Impact: The Systematic Assessment and Quantification of the Impact of Treatment Adherence on Pediatric Medical and Psychological Outcomes

OBJECTIVE Treatment adherence impact (TAI) is the quantification of the effects of adherence behaviors on medical or psychological outcomes using systematic assessment and analytic methods. The purpose of this review is to provide a framework for the measurement and analysis of TAI. METHODS Specific studies were selected from the treatment adherence literature to illustrate methods to assess TAI. RESULTS There are many methods available to investigators to evaluate TAI and, when possible, multiple impact outcomes should be included in adherence studies. The methods available to assess TAI and barriers to assessing TAI vary across illness group requiring illness-specific applications of the concepts presented. CONCLUSIONS Systematically examining TAI in adherence studies could advance the state of the art of treatment adherence science.

Assessing Medication Adherence as a Standard of Care in Pediatric Oncology.

Poor adherence to pediatric cancer treatment protocols may prevent children and adolescents from realizing the potential benefits of therapy. This paper presents the evidence for a standard of care for supporting medication adherence. Databases were reviewed for articles examining adherence and including children and/or adolescents with cancer. Fourteen articles (i.e., qualitative, quantitative, review, and randomized clinical trials) were evaluated for rigor. There is moderate‐quality evidence to support a strong recommendation for adherence to be assessed routinely and monitored throughout the treatment. Integrating the proposed clinical procedures into standard clinical care may improve outcomes for children and adolescents with cancer.

Assessing psychosocial risk in pediatric inflammatory bowel disease: validation of the Psychosocial Assessment Tool 2.0_General.

Aim: The aim of this study was to present the preliminary psychometric properties of the Psychosocial Assessment Tool 2.0_General (PAT2.0_GEN), a brief screener for psychosocial risk in families of children with inflammatory bowel disease (IBD). Methods: Caregivers of 42 youth with IBD were recruited and administered a battery of measures including the PAT2.0_GEN and well-validated measures of child emotional and behavioral functioning at baseline and at a 6-month follow-up. Results: Internal consistency for the PAT2.0_GEN total score was good (&agr; = 0.82). Baseline was significantly associated with the 6-month follow-up (r = 0.79, P < 0.001). Significant correlations between the baseline PAT2.0 _GEN total score and caregiver-reported Child Behavior Checklist total scores at baseline (r = 0.74, P < 0.001) and at a 6-month follow-up (r = 0.62, P < 0.001) support the content and predictive validity of the PAT2.0_GEN. Baseline PAT2.0_GEN was also significantly correlated with youth-reported Child Behavior Checklist total scores at baseline (r = 0.37, P = 0.02) but not at the 6-month follow-up (r = 0.23, P = 0.17). Conclusions: A number of indicators support the concurrent and predictive utility of the PAT2.0_GEN. The PAT2.0_GEN is a promising tool for screening psychosocial risk that could facilitate the provision of psychosocial services to those patients most in need.

Medication adherence decision-making among adolescents and young adults with cancer.

PURPOSE Nearly half of all adolescents and young adults (AYAs) with cancer struggle to adhere to oral chemotherapy or antibiotic prophylactic medication included in treatment protocols. The mechanisms that drive non-adherence remain unknown, leaving health care providers with few strategies to improve adherence among their patients. The purpose of this study was to use qualitative methods to investigate the mechanisms that drive the daily adherence decision-making process among AYAs with cancer. METHODS Twelve AYAs (ages 15-31) with cancer who had a current medication regimen that included oral chemotherapy or antibiotic prophylactic medication participated in this study. Adolescents and young adults completed a semi-structured interview and a card sorting task to elucidate the themes that impact adherence decision-making. Interviews were transcribed verbatim and coded twice by two independent raters to identify key themes and develop an overarching theoretical framework. RESULTS Adolescents and young adults with cancer described adherence decision-making as a complex, multi-dimensional process influenced by personal goals and values, knowledge, skills, and environmental and social factors. Themes were generally consistent across medication regimens but differed with age, with older AYAs discussing long-term impacts and receiving physical support from their caregivers more than younger AYAs. CONCLUSIONS The mechanisms that drive daily adherence decision-making among AYAs with cancer are consistent with those described in empirically-supported models of adherence among adults with other chronic medical conditions. These mechanisms offer several modifiable targets for health care providers striving to improve adherence among this vulnerable population.

The Relationship of Maternal and Child Illness Uncertainty to Child Depressive Symptomotology: A Mediational Model

OBJECTIVE To examine the relationship of parent and child ratings of illness uncertainty to depressive symptomotology in children with a chronic illness using a mediational model framework. METHOD Mother-child dyads (N = 103 pairs) each completed measures of perceived illness uncertainty, while youth also completed a measure of depressive symptomotology. RESULTS Maternal uncertainty was directly related to child depressive symptoms; however, this relationship was mediated by child uncertainty. CONCLUSION It would appear that a key mechanism by which parent-related uncertainty influences child depressive symptoms is through child uncertainty, underscoring the importance of examining cognitive appraisal variables and means of transmission in parent-child interactions.

Correspondence Between Objective and Subjective Reports of Adherence Among Adolescents With Acute Lymphoblastic Leukemia

This study examined the relation between self-reported oral medication adherence and bioassay adherence indicators among adolescents with acute lymphoblastic leukemia (ALL). Fifty-one adolescents with ALL, who were prescribed 6-mercaptopurine (6MP), were recruited. Adherence was assessed via 6MP metabolites at Days 28, 56, and 112 and adolescent report at Days 56 and 112. Forty-five percent of adolescents reported missing a dose of 6MP, and 53% had bioassay results indicative of nonadherence. Adolescents with lower self-reported adherence were 3.5 times more likely to have low levels of 6MP metabolites. Both self-report and bioassay data confirm the prevalence of 6MP nonadherence among adolescents with ALL.