Brenda Bursch

Construction and Validation of Four Childhood Asthma Self-Management Scales: Parent Barriers, Child and Parent Self-Efficacy, and Parent Belief in Treatment Efficacy

This study examined the psychometric properties of four new health belief measures for asthmatic children and their parents. A total of 110 asthmatic children (aged 7-15) and 129 parents (with asthmatic children aged 3-15) responded to a mail-out survey. Evidence for reliability (0.75-0.87) and validity was obtained for measures of Parent Barriers to Managing Asthma, Parent Asthma Self-Efficacy (subscales: attack prevention and attack management), Parent Treatment Efficacy, and Child Asthma Self-Efficacy (subscales: attack prevention and attack management). All measures were correlated in the hypothesized directions with health status, asthma symptoms, and impact of illness on the family.

Evaluation of a Family-Centered Prevention Intervention for Military Children and Families Facing Wartime Deployments

OBJECTIVES We evaluated the Families OverComing Under Stress program, which provides resiliency training designed to enhance family psychological health in US military families affected by combat- and deployment-related stress. METHODS We performed a secondary analysis of Families OverComing Under Stress program evaluation data that was collected between July 2008 and February 2010 at 11 military installations in the United States and Japan. We present data at baseline for 488 unique families (742 parents and 873 children) and pre-post outcomes for 331 families. RESULTS Family members reported high levels of satisfaction with the program and positive impact on parent-child indicators. Psychological distress levels were elevated for service members, civilian parents, and children at program entry compared with community norms. Change scores showed significant improvements across all measures for service member and civilian parents and their children (P < .001). CONCLUSIONS Evaluation data provided preliminary support for a strength-based, trauma-informed military family prevention program to promote resiliency and mitigate the impact of wartime deployment stress.

Families Overcoming Under Stress: Implementing Family-Centered Prevention for Military Families Facing Wartime Deployments and Combat Operational Stress

The toll of multiple and prolonged deployments on families has become clearer in recent years as military families have seen an increase in childhood anxiety, parental psychological distress, and marital discord. Families overcoming under stress (FOCUS), a family-centered evidence-informed resiliency training program developed at University of California, Los Angeles and Harvard Medical School, is being implemented at military installations through an initiative from Navy Bureau of Medicine and Surgery. The research foundation for FOCUS includes evidence-based preventive interventions that were adapted to meet the specific needs of military families facing combat operational stress associated with wartime deployments. Using a family narrative approach, FOCUS includes a customized approach utilizing core intervention components, including psychoeducation, emotional regulation skills, goal setting and problem solving skills, traumatic stress reminder management techniques, and family communication skills. The purpose of this study is to describe the development and implementation of FOCUS for military families. A case example is also presented.

Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions)

&NA; Despite frequent targeting of health beliefs in pediatric chronic pain treatment interventions, there are currently no reliable and valid self‐efficacy measures for children with chronic pain and their parents. The current study examined the psychometric properties of parent and child versions of a self‐efficacy measure related to the child functioning normally when in pain. Pediatric pain patients, 9–18 years of age, and a caregiver completed questionnaires before an initial tertiary care clinic appointment. The 67 patients in our sample had an average of 1.7 pain locations, including abdominal pain (43.3%), headaches (50.7%), body pain (25.4%), back pain (23.9%), limb pain (20.9%), and/or chest pain (9.0%). Reliability for the new measures was excellent; the Cronbachs alpha was .89 for the 7 child items and .90 for the 7 parent items. Strong evidence for construct validity was also obtained as 23 of the 27 hypothesized correlations were confirmed. As predicted, parent and child ratings of increased self‐efficacy for the child functioning normally when in pain were significantly correlated with each other, and to parent reports of fewer problems functioning due to physical or emotional problems; parent reports of fewer somatic, behavioral or emotional symptoms; parent reports of increased self‐esteem, and unrelated to child pain, age and gender. Additionally, child ratings of increased self‐efficacy were significantly correlated with child reports of increased self‐esteem and fewer somatic symptoms. Replication with a larger sample size, more complex modeling, and prospective studies are indicated.

Position Paper: Definitional Issues in Munchausen by Proxy

In 1996, a multidisciplinary task force of experts was created to develop working definitions for the constellation of behaviors currently described as Munchausen by proxy (MBP). The aim of the task force was to develop a synthesis of the most current thinking in pediatrics, psychiatry, psychology, child protection, and law and to articulate the current consensus among professionals to facilitate the identification and treatment of this complex clinical problem. The term Munchausen by proxy was first used by Roy Meadow (1977), a British pediatrician, to describe illness-producing behavior reminiscent of adult Munchausen syndrome but using the child as a proxy. Adult Munchausen syndrome, described in 1951 by Asher, is a psychiatric disorder in which an adult intentionally induces or feigns symptoms of physical or psychiatric illness to assume the sick role. MBP was initially described as “the intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual’s care for the purpose of indirectly assuming the sick role” (American Psychiatric Association, 1994, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. [DSM-IV], p. 475). The fact that Munchausen syndrome and MBP share the same name has resulted in considerable confusion. Although once thought to be quite rare, most experts now believe that MBP is fairly common. Using the results of a careful but conservative British study (McClure, Davis, Meadow, & Sibert, 1996), we estimate that a minimum of 600 new cases of just two forms of MBP (suffocation and nonaccidental poisoning) will present in the United States each year. Given the wide spectrum of pediatric conditions that have been known to be feigned, the problem is far from trivial. Furthermore, experts now agree that MBP

Visceral pain-associated disability syndrome: a descriptive analysis.

Objective Pain-associated disability syndrome (PADS) is a recently defined term that describes patients with chronic pain whose restriction in daily activities appears disproportionately severe for the observable pathology. The aim of this study is to describe the features of a group of pediatric patients with abdominal symptoms fitting this diagnosis. Methods To identify factors associated with visceral PADS, we reviewed the records of 40 patients (18 males; age range, 7–21 years) with gastrointestinal symptoms severe enough to prevent school attendance or eating for 2 months or more. These patients, in whom pain was neither feigned nor self-induced, met the diagnostic criteria for visceral PADS, including failure of usual treatments and lack of a satisfactory organic explanation for the severity of the pain. Results The dominant symptom was abdominal pain in 30 patients, regurgitation in 5 patients, nausea in 3 patients, and chest pain in 2 patients. All patients complained of pain or discomfort, and all met symptom-based criteria for one or more functional gastrointestinal disorder. Disordered sleep was a problem for 39 patients. Factors associated with PADS included learning disabilities, unrealistic goals in a perfectionist, high-achieving child, early pain experiences, passive or dependent coping style, marital problems in the home, and chronic illness in a parent. All patients had at least two associated factors, and a majority had four or more associated factors. Possible triggering events included an acute febrile illness in 20 patients, school change in 11 patients, trauma in 2 patients, death of a loved one in 2 patients, and sexual abuse in 2 patients. Before diagnosis, all patients underwent extensive negative evaluations. Nearly all patients had mental health evaluations that ruled out eating disorder and psychosis. Medical management had failed, and surgeries worsened symptoms. In a majority of patients, we identified a comorbid psychiatric disorder. Conclusions Evaluation of preteens and teens unable to go to school or eat because of unexplained incapacitating symptoms should include queries about factors associated with PADS. To treat PADS, medical and mental health clinicians must recognize pain as having both nociceptive and affective components and address treatment collaboratively. Invasive procedures and surgery reinforce the cycle of arousal and pain and are to be avoided. Age for the onset of PADS in the preteen and early teen years suggests that developmental issues play a role.

Laboratory pain reactivity and gender: relationship to school nurse visits and school absences.

ABSTRACT. Currently, there are no clear methods for identifying children vulnerable to frequent school absences. Our study examined relationships between gender and laboratory pain reactivity to the cold-pressor task (CPT), and parent-involved school absences and self-initiated school nurse visits in 57 children (36 female; ages 8–10 years). Using multiple regression analyses, CPT pain ratings, tolerance, and gender were analyzed in relation to nurse visits and absences collected prospectively across 2 years. We found that higher pain ratings and female gender predicted more absences; female gender also predicted increased nurse visits for acute complaints with documented physical findings. Our results suggest that laboratory pain reactivity is a potentially useful indicator of vulnerability to parent-involved functional impairment, as indexed by school absences, and that girls are more likely than boys to miss school and visit the nurse for acute illnesses. Limitations and pathways for further study are discussed.

Forensic Assessment of Illness Falsification, Munchausen by Proxy, and Factitious Disorder, NOS:

The purpose of this article is to propose guidelines for the evaluation of possible Munchausen by proxy child abuse for the court systems. These assessments require the evaluator to have an understanding of the complexity involved when this type of abuse is alleged. The evaluator should have an appreciation of how falsification of illness may or may not occur, recognize the need for careful analysis of medical records, and understand the problems associated with the use of a profile in determining the validity of an abuse allegation. This article presents guidelines for gathering pertinent data, analyzing records, and evaluating psychological testing for forensic evaluations when the questions for the evaluation are the following: (a) Is there evidence that child abuse did occur? (b) Does the alleged perpetrator meet criteria for factitious disorder, NOS (or factitious disorder by proxy)? and (c) What management and treatment recommendations should be made?

Family-Based Processes Associated with Adolescent Distress, Substance Use and Risky Sexual Behavior in Families Affected by Maternal HIV.

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother–adolescent (ages 12–21) dyads (N = 264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth aggressive conflict style, maternal bonding, maternal role reversal expectations, and overall family functioning. Results of structural equation modeling indicated that youth aggressive conflict resolution style was strongly associated with adolescent distress, substance use, and risky sexual behavior. In HIV-affected families, youth less frequently reported using an aggressive conflict resolution style and more frequently reported positive maternal bonds; their mothers reported less positive family functioning than control families. Finally, maternal distress indirectly affected adolescent distress and risk behavior via youth aggressive conflict resolution style.

Developmental predictors of somatic symptoms in adolescents of parents with HIV : A 12-month follow-up

ABSTRACT. Adolescents of parents with HIV provide a test for proposed risk factors for somatic symptoms. This study prospectively examined family and developmental predictors of somatic symptoms in a high-risk community sample. A longitudinal latent variable model predicted adolescent somatization scores from the Brief Symptom Inventory 12 months after baseline assessment of 211 parent-adolescent pairs. In this cohort, somatic symptoms during adolescence persisted over time (p < .001) and were predicted by female gender (p < .05). In addition, (1) parental distress over pain predicted adolescent somatic symptoms at baseline and follow-up (p < .001), (2) adolescents who experienced their parents as highly rejecting reported more somatic symptoms at follow-up (p < .001), and (3) school problems correlated with somatic symptoms (p < .001), as well as parental rejection (p < .001), at baseline. These findings underscore potential relationships among parental illness, parent-child relationships, and somatic distress. Adolescents with school problems are particularly vulnerable, at least in the short run. These data support a family-based approach to treatment programs for adolescents with increased levels of somatic distress.