Alyssa Lundahl

Parental Underestimates of Child Weight: A Meta-analysis

BACKGROUND AND OBJECTIVE: Parental perceptions of their children’s weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children’s weight and moderators of such misperceptions. METHODS: Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children’s weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models. RESULTS: A total of 69 articles (representing 78 samples; n = 15 791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%–70.2%) of parents underestimate their overweight/obese children’s weight. Significant moderators of this effect included child’s age and BMI. A total of 52 articles (representing 59 samples; n = 64 895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%–17.4%) of parents underestimate their children’s normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed. CONCLUSIONS: Half of parents underestimated their children’s overweight/obese status and a significant minority underestimated children’s normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.

Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis.

CONTEXT: Mixed findings exist on whether stimulant medications alter youth sleep. OBJECTIVE: To determine the effect of stimulant medications on sleep. DATA STUDIES: Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed. STUDY SELECTION: Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded. DATA EXTRACTION: Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models. RESULTS: A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (−0.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (−0.59) was significant, such that stimulants led to shorter sleep duration. LIMITATIONS: Limitations include few studies, limited methodologic variability, and lack of unpublished studies. CONCLUSIONS: Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.

Sleep and food intake: A multisystem review of mechanisms in children and adults

The foods we eat have substantial impact on our health, and excessive food intake is associated with numerous long-term health conditions. It is therefore essential to understand the factors influencing this crucial health behavior. Research has identified sleep problems as one such factor; however, little research has examined how sleep problems impact food intake. Using a multisystemic perspective, this article proposes a variety of ways in which sleep problems likely increase food intake and illustrates the need for research to empirically examine these underlying mechanisms. Such research would have important treatment implications for health conditions often treated with dietary interventions.

Psychosocial Stressors and Health Behaviors Examining Sleep, Sedentary Behaviors, and Physical Activity in a Low-Income Pediatric Sample

Objective. To better understand the relationship between psychosocial stressors and health behaviors in a low-income pediatric sample. Method. Participants were 122 children (8-11 years old, 53.3% female) and their parents recruited from a low-income primary care clinic. Measures assessed child stressors and parental financial strain, and child sleep problems, sedentary behaviors, and physical activity. Results. Parental financial strain and child stressors were independently associated with sleep problems and sedentary behaviors, controlling for age and gender. Though stressors in general accounted for significant variance in physical activity, results indicate a complex relationship as parental financial strain predicted more physical activity and child stressors predicted less physical activity. Conclusion. Stressors are associated with adverse pediatric health behaviors. Consequently, chronic stressors could negatively affect long-term health, and interventions targeting stressors and health behaviors are indicated. Pediatric health care providers play a key role in promoting health behaviors among youth experiencing significant psychosocial stressors.

Estimating Child Sleep From Parent Report of Time in Bed: Development and Evaluation of Adjustment Approaches

OBJECTIVE To develop and evaluate adjustment factors to convert parent-reported time in bed to an estimate of child sleep time consistent with objective measurement. METHODS A community sample of 217 children aged 4-9 years (mean age = 6.6 years) wore actigraph wristwatches to objectively measure sleep for 7 days while parents completed reports of child sleep each night. After examining the moderators of the discrepancy between parent reports and actigraphy, 3 adjustment factors were evaluated. RESULTS Parent report of child sleep overestimated nightly sleep duration by ∼24 min per night relative to actigraphy. Child age, gender, and sleep quality all had small or nonsignificant associations with correspondence between parent report and actigraph. Empirically derived adjustment factors significantly reduced the discrepancy between parent report and objective measurement. CONCLUSIONS Simple adjustment factors can enhance the correspondence and utility of parent reports of child sleep duration for clinical and research purposes.

Gender differences in the relationship between impulsivity and disordered eating behaviors and attitudes

OBJECTIVE We investigated relationships among gender, impulsivity and disordered eating in healthy college students. METHOD Participants (N=1223) were healthy, undergraduate men (28.5%) and women (71.5%), who completed the Barratt Impulsiveness Scale - Version 11 (BIS-11) and a four-factor version of the Eating Attitudes Test (EAT-16). RESULTS As predicted, mean scores on all four EAT-16 factors were significantly higher for women than for men. Attentional impulsivity was related to poorer self-perception of body shape, more dieting, and a greater preoccupation with food for the sample as a whole. Moreover, motor impulsivity was related to poorer self-perceptions of body shape and a greater preoccupation with food. However, no gender differences emerged in the relationship between impulsivity and disordered eating attitudes. DISCUSSION This study elucidates the role of impulsivity in disordered eating behaviors among non-clinical college students. For both women and men, attentional and motor impulsivity were related to disordered eating attitudes and behaviors. Overall, these findings suggest that different facets of impulsivity are related to disordered eating attitudes and behaviors in a non-clinical college population.

A Meta-Analysis of the Effect of Experimental Sleep Restriction on Youth's Attention and Hyperactivity.

This meta-analysis examined the effect experimental sleep restriction has on youth’s attention and hyperactivity outcomes. Thirteen published studies containing 17 independent samples were included (N = 496). Random- and fixed-effects models were used to estimate pooled effect sizes and moderator effects, respectively. Results indicate that sleep-restricted youth had significantly worse attention outcomes than youth with extended sleep, but no differences were evident regarding hyperactivity. Significant moderators of this effect included age and sex. These results have important implications for both the prevention and treatment of attention problems, highlighting the need for health professionals to screen for and treat underlying sleep issues.

Attention deficit hyperactivity disorder symptomatology and pediatric obesity: Psychopathology or sleep deprivation?

The relationship between attention deficit hyperactivity disorder (ADHD) and obesity in children has received considerable attention in recent years. However, the literature currently overlooks the potential causal and maintaining role that sleep problems may play in this relationship. Using a biopsychosocial framework, this article highlights how sleep problems impact the biological, psychological, and social aspects of both ADHD symptomatology and obesity. An in-depth examination of this model illustrates the imperative need for future research and clinical practice to recognize and explore the role sleep has in the link between obesity and ADHD symptomatology.

Early executive control and risk for overweight and obesity in elementary school.

ABSTRACT An emerging literature suggests that poor executive control (EC) may be associated with clinical weight problems, e.g., body mass index (BMI) for age percentile ≥85 in children. However, our understanding of the impact of EC on overweight and obesity in childhood is limited by the lack of longitudinal studies spanning critical developmental periods and assessing EC using comprehensive performance-based batteries. The current study addresses these limitations in a longitudinal examination of 212 children who completed an extensive laboratory-based EC task battery in preschool (age 4 years and 6 months) and were followed through elementary school (Grades 1 through 4) with objective measures of weight status. The logistic regression results indicate that poorer EC in preschool is associated with significantly greater risk for clinical weight problems (either overweight or obese status, as defined by BMI-for-age percentile ≥ 85) in elementary school, controlling for maternal education. EC in preschool was not significantly associated with risk for obese status, specifically (defined by BMI-for-age percentile ≥ 95), but the trend was in the expected direction. The results suggest that early executive abilities are relevant for children’s subsequent health status, with deficits in EC in the critical period of preschool conferring risk for later problems with weight. Based on these findings, early interventions to promote stronger EC may be a promising, yet currently overlooked, component in pediatric obesity prevention efforts.

Overweight and Obesity Among Youth Entering Residential Care: Prevalence and Correlates

Little is known about the prevalence of clinical weight problems for youth living in residential care. Therefore, this study examined the prevalence and correlates of overweight and obesity in a large sample of youth (N = 1709) entering a residential care program. Results indicated that 48% of youth were overweight or obese at the time of intake, which is much higher than national pediatric rates. Females had higher rates of overweight/obesity, as did youth referred from moderately restrictive placements such as foster care. Youth who were overweight/obese had greater internalizing symptoms at intake. Clinical and research implications are discussed.