Beth G. Wildman

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems.

The Role of Stigma in Parental Help-Seeking for Child Behavior Problems

The present study examined the relationship between stigma and parental help-seeking after controlling for demographics, child behavior, and barriers to treatment. One hundred fifteen parents of children ages 4 to 8 years were surveyed during well-child visits in a rural pediatric primary care practice. Parental perceptions of stigma toward parents and children were both assessed. Parents believe that children are more likely to be stigmatized by the public and personally impacted by stigma. In linear regression analyses, parents rated themselves as more likely to attend parenting classes with lower levels of self-stigma and greater levels of personal impact of stigma. Stigma toward the child was not associated with help-seeking. Child behavior moderated the relationship between stigma and parental help-seeking. When referring parents to treatment, providers should address potential stigma concerns. Future research should assess both the impact of the stigma of attending treatment and the stigma of having a child with behavior problems.

Impact of age and gender on adherence to infection control guidelines and medical regimens in cystic fibrosis

The goal of the present research was to examine the impact of age and gender on adherence to both infection control (IC) guidelines and traditional medical treatments in a cystic fibrosis (CF) population. Adherence behaviors are consistently suboptimal in chronic illness populations, particularly pulmonary diseases; understanding the factors related to adherence behaviors in CF can aid in the development of interventions to promote adherence.

An investigation into the relationships between gender and language

The present investigation focused upon the impact of gender and various “powerful” and “less powerful” linguistic features on the communication of unfamiliar male and female college students. Same-sex and mixed-sex dyads were recorded as they engaged in discussions regarding suggestions for a bogus freshman orientation booklet. Although few gender differences were found, the result of a factor analysis yielded three factors: questions, suggestions, and process variables. These factors are consistent with a power perspective in the use of various linguistic features. However, the present findings suggest that gender and power alone cannot explain differences in communication styles. Rather, the results suggest the need to consider other aspects of the speaker to explain differences that occur in the use of language.

The impact of dysmenorrhea on daily activities

Abstract Dysmenorrhea has been considered a leading cause of occupational and school absenteeism among women, yet little is known about its actual impact and factors relating to its impact. Questionnaires about menstrual experiences, activities missed due to dysmenorrhea, perceptions of the consequences of missing these activities and questionnaires concerned with self-control and attitudes toward menstruation were administered to 293 college women twice, in a retrospective and prospective manner. Multiple regressions indicated that activity changes were influenced by menstrual symptoms, feelings of debilitation and perceived consequences of the activities missed. Although pain was a significant predictor of activities missed, results indicated that other cognitive factors accounted for a significant portion of the variance in predicting missed activities. These results were found in spite of the finding that the majority of women reported using medications specifically marketed for menstrual pain.

Teacher perception of burden and willingness to accommodate children with chronic health conditions

Children with chronic health conditions need the support of school staff to flourish socially and academically in educational settings. This study explored teacher experiences and knowledge of the following common paediatric conditions: asthma, food allergies, cancer, diabetes, HIV/AIDS, heart disease and seizure disorder. Participants included 140 elementary education teachers. This study also explored teacher perceptions of willingness and burden in implementing a range of classroom accommodations. Findings revealed that teachers were less willing to implement accommodations that were perceived to be burdensome. In addition, teachers perceived HIV/AIDS and seizure disorder to be among the most challenging conditions, and they reported the least amount of exposure to childhood cancer, heart disease, HIV/AIDS and seizure disorder. Suggestions to enhance the educational experiences of students with chronic illness are provided. Specifically, expanded collaborative roles for school-based mental health practitioners are recommended.

Group conversational-skills training and social validation with mentally retarded adults

Seven community-dwelling, mildly and moderately mentally retarded adults participated in a group social skills training program designed to improve conversational skills. A group multiple-baseline design was used. Conversational components trained were asking questions about the conversational partner, giving compliments, and appropriately disclosing information about oneself. Training sessions consisted of instructions, modeling, and behavioral rehearsal. Assessment during baseline and treatment consisted of recording conversations between subject dyads after each session. Generalization of training was assessed during baseline and treatment and at 1-month, 3-month, and 6-month follow-ups by recording conversations between subjects and novel, nonretarded persons. Behavioral ratings of the tapes indicated substantial improvements in the targeted behaviors as a function of training. Subjective social validity ratings of pretraining and posttraining generalization tapes by community volunteers reflected improvements in their social perceptions of subjects as a function of training. The results suggest that community-dwelling, mentally retarded adults can be taught to make changes in their conversational behavior that are viewed positively by others living in their communities.

Factors related to medical help-seeking in women with menstrual discomfort.

Abstract Dysmenorrhea, or painful menstruation, is frequently reported by women, particularly those women in the 17–25 yr age range. However, a small percentage of these women actually seek help for their menstrual discomfort from health professionals. This study delineated some factors which were related to womens help-seeking behavior for menstrual discomfort. A model that has been used in general medical consultation was utilized in selecting the potentially discriminating variables, such as symptomatology, health beliefs and attitudes and maladjustment. The Ss were 383 college women between the ages of 17 and 25 yr. The independent variables were entered into a discriminant function analysis on a random subsample ( n = 192), the remainder of the sample ( n = 191) was reserved for cross-validation. The results indicated that symptomatology and health beliefs were important determinants of help-seeking in both samples. The maladjustment variable was not predictive of help-seeking for menstrual discomfort. Although the analyses resulted in a significant discrimination between those women who had sought help and those who had not, only 17–20% of the variance was accounted for. From this it was concluded that other variables needed to be considered, such as sociocultural factors and use of nonmedical coping strategies.

Assertive, Empathic Assertive, and Conversational Behavior: Perception of Likability, Effectiveness,and Sex Role

The present study examined the impact of assertion, empathic assertion, and conversational behavior on the perception of likability and sex-role orientation of the asserter. Findings suggested that empathic comments mitigated the negative impact of assertion. Perceptions of sex-role indicated that males viewed assertive models as either androgynous or masculine whereas females tended to classify assertive models as masculine. Both males and females rated empathic assertive models as either androgynous or masculine. Possible clinical implications of sex-role-consistent assertive behavior and explanations for lack of assertiveness are discussed.

Mothers’ Help-Seeking for Pediatric Psychosocial Problems

Pediatricians have been criticized for failing to identify psychosocial problems in their pediatric patients. Maternal disclosure is important for identification; however, many mothers fail to discuss their concerns with the pediatrician. The present study explored the hypothesis that mothers are seeking and receiving help from sources other than the pediatrician. Participants were 50 mothers who brought their 4-13-year-old child for a routine health supervision visit at a county-funded hospital serving primarily low-income families. Results indicated that mothers actively seek help from multiple sources and find the help they receive useful. Clinical implications of these findings are discussed.