Edin T. Randall

Capturing Unique Dimensions of Youth Organized Activity Involvement: Theoretical and Methodological Considerations

Despite increased focus on the effects of organized activities on youth development, there is currently no consensus about the best way to assess various dimensions of involvement. This article explores the complexities of assessing involvement and focuses specifically on the following organized activity dimensions: (a) breadth, (b) intensity, (c) duration/consistency, and (d) engagement. For each dimension, the article examines the theoretical underpinnings for why it is important to measure the dimension, presents measurement issues that have arisen in previous studies, describes how the dimension relates to developmental outcomes, and offers recommendations for assessing it in future use. A conceptual model is presented to describe issues that are important to consider when assessing various dimensions of organized activity involvement in future research.

Relationships Between Discretionary Time Activities, Emotional Experiences, Delinquency and Depressive Symptoms Among Urban African American Adolescents

Using the Experience Sampling Method (ESM), this cross-sectional study examined mediated and moderated associations between different types of discretionary time activities and depressive symptoms and delinquency among a sample of 246 (107 boys, 139 girls) fifth through eighth grade urban African American adolescents. More time spent in passive unstructured activities was associated with higher levels of depressive symptoms only for adolescents residing in less dangerous neighborhoods, whereas more time spent in active unstructured activities was associated with higher levels of delinquency only if adolescents resided in more dangerous neighborhoods. Alienation was positively associated with depressive symptoms and delinquency, but neither alienation nor positive affect mediated the relationship between activities and adjustment. These findings suggest the importance of considering neighborhood environment issues when determining what types of discretionary time activities are most beneficial for urban African American young adolescents.

Understanding threshold effects of organized activity involvement in adolescents: Sex and family income as moderators

The current study examined the curvilinear links between involvement in organized activities (OA) and sport activities specifically and various indicators of psychological and social development. Participants included 150 9th and 10th graders (57% females) from an urban, selective-enrollment high school. Eligibility for admission is based on city residence, high GPA, and high scores on standardized tests and an admission exam. Findings indicated that benefits of OA involvement leveled off at approximately 5-7 h/week, with diminishing returns for adolescents participating in more than 10 h/week. Results also suggest that OA involvement uniquely impacts male and lower-income participants. Males reported threshold effects in terms of perceived friendship competence and depressive symptoms. Male sport participants and lower-income adolescents reported a similar pattern for loneliness. Findings suggest that among a high achieving sample of urban adolescents, social and psychological benefits are linked to moderate but not intense involvement in OAs and sports.

Living life with my child’s pain: The Parent Pain Acceptance Questionnaire (PPAQ)

Objective:Parents’ emotional, cognitive, and behavioral responses are highly influential on children’s pain and functional outcomes. One important response to pediatric pain is acceptance: the degree to which an individual participates in routine daily activities in the presence of pain and is willing to let pain be a part of their life without efforts to control or avoid it. However, no tool currently exists to assess parents’ own acceptance of their child’s pain. The aim of this study was to validate the Parent Pain Acceptance Questionnaire (PPAQ). Materials and Methods:The PPAQ was administered to 310 parents of youth with chronic pain in an outpatient pediatric headache program and a day hospital pain rehabilitation program. An exploratory factor analysis revealed 2 factors for the PPAQ: an 11-item Activity Engagement scale and a 4-item Acceptance of Pain-related Thoughts and Feelings scale. Results:The PPAQ total score and subscales demonstrated strong internal consistency. Greater parent pain acceptance was positively associated with child pain acceptance, and was negatively correlated with parent protective behaviors, parent minimizing behaviors, parent and child pain catastrophizing, and child fear of pain. Parent protective behaviors and child pain acceptance both served as mediators of the relationship between parent pain acceptance and child functional disability. Conclusions:The PPAQ is a valid measure of parent pain acceptance and may provide valuable insights into parent responses to child pain and the ways in which parent acceptance influences child outcomes. Clinical implications and suggestions for future research are discussed.

Somatoform Disorders and Trauma in Medically-Admitted Children, Adolescents, and Young Adults: Prevalence Rates and Psychosocial Characteristics

OBJECTIVE The purpose of this study is to describe past traumatic experiences in medically-admitted pediatric and young adult patients diagnosed with somatoform disorders and to explore the demographic, diagnostic, and psychosocial differences between those with and without trauma histories. METHODS Retrospective medical record reviews were performed for patients (aged 3-29 years) seen by the Psychiatry Consultation Service (2010-2011) at a pediatric medical hospital and diagnosed with a somatoform disorder. Clinical data collected included demographics, medical history, current physical symptoms, psychiatric diagnoses and history, trauma history, coping styles, family psychiatric and medical history, peer and family factors, psychiatric disposition after discharge, and service utilization. RESULTS The mean age of the 180 identified patients was 15.1 years. Most patients were girls (75.0%) and White (71.7%). Somatoform diagnoses were primarily pain (51.4%) and conversion disorders (28.9%). Rates of trauma were similar to national norms (29.7%). Trauma history did not correlate with age, sex, race, income, length of hospitalization, or type of somatoform disorders. However, patients with trauma histories had significantly higher rates of psychiatric comorbidities (76.0% vs. 50.8%), past psychiatric treatment (81.1% vs. 59.1%), parent mental illness (69.8% vs. 38.6%), and family conflict (52.8% vs. 37.0%) and were more likely to require inpatient psychiatric hospitalization on discharge (18.9% vs. 6.3%). CONCLUSION Prevalence of trauma in a sample of medically-admitted pediatric and young adult patients with somatoform diagnoses was similar to national norms. However, patients with a history of trauma had unique psychiatric and psychosocial profiles compared to those without a history of trauma.

Brief report: adolescent adjustment in affluent communities: the role of motivational climate and goal orientation.

Researchers now recognize that affluent youth experience tremendous achievement pressures, yet contributing factors or outcomes are rarely explored. Using a sample of affluent adolescents, the present study investigates the mediating role of goal orientation (GO) on relations between school motivational climate (MC) and adolescent adjustment. Adolescents from four high schools completed measures of MC (i.e., Performance and Mastery), GO (i.e., Ego and Task), and adjustment (i.e., depressive symptoms, anxiety, and life satisfaction). Performance climates were associated with more adjustment problems while Mastery climates were associated with fewer adjustment problems. Adolescents with higher Ego orientation reported more depressive and anxiety symptoms, while adolescents with higher Task orientation indicated fewer depressive symptoms and greater life satisfaction. Adolescent Task orientation mediated the relations between Mastery climate and two adjustment outcomes (i.e., depressive symptoms and life satisfaction). Results suggest the importance of non-competitive achievement-oriented values and collaborative school contexts in adolescent adjustment.

The cost of perfection with apparent ease: Theoretical foundations and development of the Effortless Perfectionism Scale

Effortless perfection is a term used to describe an intense pressure to be perfect without visible effort (Yee, 2003), and is thought to be linked to several indicators of maladjustment among college-age youth (Ruane, 2012; Yee, 2003). Although effortless perfectionism (EP) is a phenomenon referenced in popular culture, empirical support for this construct is needed. In addition to conceptualizing and discussing the theoretical underpinnings of EP, this paper describes the development of an instrument to assess EP: the 10-item Effortless Perfectionism scale (EPS). The responses of a large sample of students from a Midwestern university (N = 1,270) were used to develop a 1-factor measurement model for the EPS. The EPS showed good internal consistency and test-retest reliability, and demonstrated convergent, discriminant, and incremental validity in relation to other perfectionism scales, as a predictor of psychosocial adjustment, and as a mediator of the effects of gender on adjustment. The present study supports the reliability and construct validity of the EPS as a self-report measure of EP, a distinct type of perfectionism that warrants future investigation.

Children With Chronic Pain: Response Trajectories After Intensive Pain Rehabilitation Treatment

Intensive pain rehabilitation programs for children with chronic pain are effective for many patients. However, characteristics associated with treatment response have not been well documented. In this article we report trajectories of pain and functional impairment in patients with chronic pain up to 1 year after intensive pain rehabilitation and examine baseline factors associated with treatment response. Patients (n = 253) with chronic pain and functional disability were assessed at 5 time points (admission, discharge, 1-month, 4-month, and 12-month follow-ups). Individual trajectories were empirically grouped using SAS PROC TRAJ. For functional disability, 2 groups emerged: treatment responders (88%) and nonresponders (12%). Using a binomial logistic regression model to predict disability trajectory group, no baseline variables were significant predictors for the disability trajectory group. For pain, 3 groups emerged: early treatment responders (35%), late treatment responders (38%), and nonresponders (27%). Using multinomial regression analyses to predict pain trajectory group, older age, higher pain scores, fewer social difficulties, higher anxiety levels, and lower readiness to change were characteristics that distinguished nonresponders from responders; no significant predictors distinguished the late responders from the early responders. These results provide key information on the baseline factors that influence intensive pain rehabilitation outcomes, including risk factors that predict treatment nonresponse. Our findings have implications for developing more targeted treatment interventions. PERSPECTIVE Deriving groups of individuals with differing treatment response trajectories stimulates new thinking regarding potential mechanisms that may be driving these outcomes.

A Single-Arm Feasibility Trial of Problem-Solving Skills Training for Parents of Children with Idiopathic Chronic Pain Conditions Receiving Intensive Pain Rehabilitation

Objective To adapt problem-solving skills training (PSST) for parents of children receiving intensive pain rehabilitation and evaluate treatment feasibility, acceptability, and satisfaction. Methods Using a prospective single-arm case series design, we evaluated the feasibility of delivering PSST to 26 parents (84.6% female) from one of three pediatric pain rehabilitation programs. Results Parents completed four to six sessions of PSST delivered during a 2-4-week period. A mixed-methods approach was used to assess treatment acceptability and satisfaction. We also assessed changes in parent mental health and behavior outcomes from pretreatment to immediate posttreatment and 3-month follow-up. Parents demonstrated excellent treatment adherence and rated the intervention as highly acceptable and satisfactory. Preliminary analyses indicated improvements in domains of mental health, parenting behaviors, health status, and problem-solving skills. Conclusions Findings demonstrate the potential role of psychological interventions directed at reducing parent distress in the context of intensive pediatric pain rehabilitation.

Bullying Victimization in Medically Hospitalized Patients With Somatic Symptom and Related Disorders: Prevalence and Associated Factors.

OBJECTIVES The purpose of this study is to describe the prevalence of bullying victimization among medically admitted patients with somatic symptom and related disorders (SSDs) and to compare demographic, diagnostic, and psychosocial characteristics of bullied versus nonbullied patients. METHODS Medically admitted patients at a tertiary pediatric facility referred to the Psychiatry Consultation Service with somatic concerns were assessed via a quality improvement (QI) initiative, the SSD Standardized Clinical Assessment and Management Plan (SSD-SCAMP). Retrospective chart and QI data on adolescent and young adult patients assessed via SSD-SCAMP from May 2012 - December 2014 were reviewed. RESULTS Medical records of 282 patients (aged 12-22 years) diagnosed with SSDs were reviewed. Approximately 37% had a history of bullying victimization. Compared with nonbullied patients, bullied patients had higher somatization scores, more functional neurologic symptoms, and longer admissions. Bullied patients also had higher rates of comorbid anxiety, suicidal histories, and family psychiatric histories. Furthermore, bullied patients also had higher rates of learning disabilities and school accommodations and endorsed more significant life events within the year before hospitalization. CONCLUSIONS This study describes the unique health and psychosocial challenges experienced by medically hospitalized bullied adolescents and young adults with SSDs. The findings highlight the importance of a multidisciplinary approach to assessment and management. By implementing QI initiatives such as the SSD-SCAMP, providers can bridge the gap between the clinical needs and long-term management of patients with SSDs.