Dennis C. Harper

Effects of distraction on children's pain and distress during medical procedures: a meta-analysis

BACKGROUND It is difficult to determine the usefulness of distraction to decrease childrens distress behavior and pain during medical procedures because many studies use very small samples and report inconsistent findings. OBJECTIVES To investigate the mean effect sizes across studies for the effects of distraction on young childrens distress behavior and self-reported pain during medical procedures. METHOD Hunter and Schmidts (1990) procedures were used to analyze 16 studies (total n = 491) on childrens distress behavior and 10 studies (total n = 535) on childrens pain. RESULTS For distress behavior, the mean effect size was 0.33 (+/-0.17), with 74% of the variance accounted for by sampling and measurement error. For pain, the mean effect size was 0.62 (+/-0.42) with 35% of the variance accounted for. Analysis of studies on pain that limited the sample to children 7 years of age or younger (total n = 286) increased the amount of explained variance to 60%. CONCLUSIONS Distraction had a positive effect on childrens distress behavior across the populations represented in this study. The effect of distraction on childrens self-reported pain is influenced by moderator variables. Controlling for age and type of painful procedure significantly increased the amount of explained variance, but there are other unidentified moderators at work.

Management of cerebral palsy: equinus gait.

On 27th to 28th February 2000, a multidisciplinary workshop was convened in the USA to explore the current state of knowledge, best clinical practice, and research needs for the management of equinus gait associated with cerebral palsy (CP). The workshop began with a brief review of CP epidemiology, and an inquiry into the current understanding of the natural history of equinus. Attention then shifted to indications for and goals of intervention; a summary of interventional approaches; the criteria by which successful intervention is evaluated; and, finally, research opportunities. What follows is an overview of the workshop.

Parents as Distraction Coaches During IV Insertion: A Randomized Study

This study investigated the effectiveness of a brief Distraction Education intervention for parents prior to their preschool childrens medical procedures. Forty-four preschool children with chronic non-life-threatening conditions were having intravenous catheters (IVs) placed for medical tests. Parent-child dyads were randomized into two groups. The experimental group received Distraction Education prior to IV insertion; the control group received standard care. Data were analyzed for two phases of the IV procedure. Phase 1 was the preparation for needle insertion; Phase 2 began with needle insertion. Experimental group parents used significantly more distraction than did control group parents during both phases (P < 0.001). There were no group differences for child behavioral distress or self-report of pain. There was a trend toward a group by phase interaction for behavioral distress (P = 0.07); more experimental group children showed decreased behavioral distress over time (from phase 1 to phase 2) than did control group children (P = 0.02).

Schoolteachers' Experiences With Childhood Chronic Illness

The objective of this study was to examine the degree to which educators face problems associated with chronic illness in their pupils, the extent to which they feel responsible for addressing such problems, and the amount of training to deal with these problems. One hundred schools randomly selected from 10 counties in a midwest state stratified on substance abuse deaths, mental health costs, and socioeconomic status (percentage of free lunches) were approached, and 17 agreed to participate. Of the 1,184 eligible educators, 480 provided complete surveys (response rate = 40%). Nearly every respondent (98.7%) reported knowing a student in the school with a chronic illness, and 43% felt moderately to very responsible for dealing with issues of chronic illness, yet 59% reported no academic training and 64% reported no on-the-job training for dealing with issues of chronic illness. Schoolteachers are ill-prepared to deal with issues of chronic illness in the schools. Practice implications are discussed.

Personality Profiles of Physically Impaired Adolescents.

Investigated MMPI profiles between two groups of adolescents with dissimilar disabilities (cleft lip/palate, orthopedic) who displayed observable physical impairment. The findings support the contention that type of disability has differential effects on adolescent personality characteristics. However, the profile elevations are consistent with previous reports of behavioral inhibition in both disability groups. Adolescents with impairments of the cleft lip/palate display greater self-concern and ruminative self-doubt over interpersonal interactions. The orthopedically impaired group exhibit an isolative and passive orientation to interpersonal interactions, as well as more generalized feelings of alienation.

Children's attitudes to physical differences among youth from Western and non-Western cultures.

Children with visible physical impairments (cosmetic and orthopedic) are known to experience difficulties in social interaction with peers. Some of these social difficulties are related to attitudes toward visible physical features of children. Several research studies from Western and non-Western countries are reviewed, focusing on childrens attitudes toward children with facial disfigurement. Specific social preferences for particular disabilities are noted which are related to cultural and economic factors. Childrens attitudes toward facial disfigurement reflect generally low preference for social interaction in the majority of cultures studied. Childrens attitudes reflect both positive and negative attributions toward facial disfigurement.

Relations Between Visual and Auditory Continuous Performance Tests in a Clinical Population: A Descriptive Study

Increased interest in auditory continuous performance tests (CPTs) exists despite the absence of a clear understanding about this procedure. The relation between auditory and visual CPTs and associations with IQ, achievement, and memory are evaluated in a referred sample of 634 children, ages 5.5 to 17.9. Age effects are found with CPT performance, regardless of modality. Total number correct or number of commissions correlations across tasks were greater than within-task number correct-number of commissions relations. The mean visual minus auditory correct difference score was 7.01; the mean commission difference score was -.85. Difference scores decreased with age and were not consistently related to other measures. Those with the lowest number correct on both CPTs (<25th percentile) were younger and had weaker short-term auditory memory and verbal learning skills; those falling in the problem quartile on commissions (>75th percentile) were younger and had poorer reading, verbal memory, and verbal learning. Total error scores (omissions + commissions) were inversely related to age. The auditory CPT has clinical utility, but other factors must be considered.

Presidential address: Social psychology of difference: Stigma, spread, and stereotypes in childhood.

This article reviews how children may conceptualize and think about peers with visible physical differences, discusses the development of stereotypes about physical disability, and summarizes research conducted by the author and his colleagues on this process of childrens perception of physical differences. Research findings from several cultures are presented and discussed. In 1983, my colleagues and I began a series of studies exploring nondisabled childrens views and social preferences toward peers with visible physical differences of the body. More than 1,000 children in six countries have been interviewed in the course of these studies since their inception (Harper, 1995). This prospective, longitudinal series of studies has focused on childrens views of physical differences and was based on the methodology of Stephen Richardson (1976) and colleagues. The methodology consists of a controlled interview technique using a standard set of line drawings of children differing only with respect to specific physical disability characteristics. Children are asked to rank their social preferences (e.g., who they like best). Values and attitudes are inferred from this task, and subsequent preference rankings by groups of children are identified. This article briefly reviews how children may conceptualize and think about physical differences, discusses the development of stereotypes about physical disability, and summarizes our key research findings on this process of childrens perception of physical differences. Preliminary definitions and introducDennis C. Harper, College of Medicine, University of Iowa. An earlier version of this article was presented as a presidential address (Division of Rehabilitation Psychology) in memory of Harold Yuker at the 106th Annual Convention of the American Psychological Association, August 1998, San Francisco. California. Correspondence concerning this article should be addressed to Dennis C. Harper, PhD, ABPP, College of Medicine, Universi ty Hospital School, Office 341, 100 Hawkins Drive, Iowa City, Iowa 52242-1011. Electronic mail may be sent to dennis-harper@uiowa.edu.

Children of the Philippines: attitudes toward visible physical impairment.

OBJECTIVE This pilot study was designed to evaluate childrens attitudes and understanding of physical disabilities with special reference to those with craniofacial anomalies in the Philippines. Children with and without craniofacial anomalies were studied. DESIGN This was a two-group correlational design with additional statistical assessment of subgroup differences. Each group was interviewed and information obtained on a standard disability preference task, attributions for playmate choice, and frequency of contact with disabilities. Parents completed a structured interview. SETTING Participants were 122 children recruited from Negros, Philippines. PARTICIPANTS Fifty-four children with craniofacial anomalies (aged 7 to 12 years) were enrolled in the study, and 68 children without any disabilities were recruited from a local school in Bacolod City, Negros, Philippines. MAIN OUTCOME MEASURES Participants completed a picture-ranking interview of specific physical disabilities and provided their reasons for their play choices and their contact with physical disabilities. RESULTS The Kendall W correlation was significant for the children with craniofacial anomalies and for those without physical disabilities. Both groups reported lower preferences for disabilities that interfere with play and social interactions. Children depicted with facial anomalies received lower preference, compared with other physical disabilities. Children with craniofacial anomalies who have experienced surgical repair reported more positive rankings for the child depicted with a facial cleft. Sex differences in disability preference were noted. CONCLUSIONS Children in the Philippines with and without craniofacial differences revealed similarities in preferences to children in several Western (United States) and non-Western countries. Children depicted with facial anomalies received lower preference than other visible physical differences. Children reported both positive and negative explanations for their disability play preferences. Facial differences may result in illogical and negative explanations for social avoidance among children. Similar reactions are noted in other parts of the world.

Children's Attitudes toward Physical Disability in Nepal A Field Study

Nepalese childrens attitudes toward peers with visible physical disabilities were studied, using a picture-ranking interview, and compared to a Western standard. Nepalese children expressed a positive preference toward peers with obesity that departed from all prior Western findings. Childrens attitudes and comments implied that body size was associated with wealth, power, and food availability. Males were more avoidant of physical disabilities that interfere with functional activities, whereas females expressed a lower preference for cosmetic disabilities (in this instance, a facial cleft). Disabilities that are physically threatening to daily functioning are reported as less common and are avoided, reflecting feelings of unfamiliarity and potential survival threat.