Gerrit Hirschfeld

Students’ conceptions of assessment: Links to outcomes

Students conceive of assessment in at least four major ways (i.e., assessment makes students accountable; assessment is irrelevant because it is bad or unfair; assessment improves the quality of learning; and assessment is enjoyable). A study in New Zealand of 3469 secondary school students’ conceptions of assessment used a self‐report inventory and scores from a standardised curriculum‐based assessment of reading comprehension. Four inter‐correlated conceptions based on 11 items were found with good psychometric properties. A path‐model linking the four correlated conceptions with student achievement in reading, while taking into account student ethnicity, student sex, and student year, had good psychometric properties. The conception that assessment makes students accountable loaded positively on achievement while the three other conceptions (i.e., assessment makes schools accountable, assessment is enjoyable, and assessment is ignored) had negative loadings on achievement. These findings are consistent with self‐regulation and formative assessment theories, such that students who conceive of assessment as a means of taking responsibility for their learning (i.e., assessment makes me accountable) will demonstrate increased educational outcomes.

Variability of "optimal" cut points for mild, moderate, and severe pain: neglected problems when comparing groups.

Summary The widely used “optimal” cut point procedure developed by Serlin et al. in 1995 results in highly variable cut points. This variability obviates any substantial interpretation of differences between groups. Abstract Defining cut points for mild, moderate, and severe pain intensity on the basis of differences in functional interference has an intuitive appeal. The statistical procedure to derive them proposed in 1995 by Serlin et al. has been widely used. Contrasting cut points between populations have been interpreted as meaningful differences between different chronic pain populations. We explore the variability associated with optimally defined cut points in a large sample of chronic pain patients and in homogeneous subsamples. Ratings of maximal pain intensity (0–10 numeric rating scale, NRS) and pain‐related disability were collected in a sample of 2249 children with chronic pain managed in a tertiary pain clinic. First, the “optimal” cut points for the whole sample were determined. Second, the variability of these cut points was quantified by the bootstrap technique. Third, this variability was also assessed in homogeneous subsamples of 650 children with constant pain, 430 children with chronic daily headache, and 295 children with musculoskeletal pain. Our study revealed 3 main findings: (1) The optimal cut points for mild, moderate, and severe pain in the whole sample were 4 and 8 (0–10 NRS). (2) The variability of these cut points within the whole sample was very high, identifying the optimal cut points in only 40% of the time. (3) Similarly large variability was also found in subsamples of patients with a homogeneous pain etiology. Optimal cut points are strongly influenced by random fluctuations within a sample. Differences in optimal cut points between study groups may be explained by chance variation; no other substantial explanation is required. Future studies that aim to interpret differences between groups need to include measures of variability for optimal cut points.

Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain

BACKGROUND AND OBJECTIVE: Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT. METHODS: Cochrane, Medline/Ovid, PsycInfo/OVID, PubMed, PubPsych, and Web of Science were searched. Studies were included if (1) treatment was coordinated by ≥3 health professionals, (2) treatment occurred within an inpatient/day hospital setting, (3) patients were <22 years, (4) patients experienced debilitating chronic pain, (5) the study was published in English, and (6) the study had ≥10 participants at posttreatment. The child’s pain condition, characteristics of the IIPT, and 5 outcome domains (pain intensity, disability, school functioning, anxiety, depressive symptoms) were extracted at baseline, posttreatment, and follow-up. RESULTS: One randomized controlled trial and 9 nonrandomized treatment studies were identified and a meta-analysis was conducted separately on pain intensity, disability, and depressive symptoms revealing positive treatment effects. At posttreatment, there were large improvements for disability, and small to moderate improvements for pain intensity and depressive symptoms. The positive effects were maintained at short-term follow-up. Findings demonstrated extreme heterogeneity. CONCLUSIONS: Effects in nonrandomized treatment studies cannot be attributed to IIPT alone. Because of substantial heterogeneity in measures for school functioning and anxiety, meta-analyses could not be computed. There is preliminary evidence for positive treatment effects of IIPT, but the small number of studies and their methodological weaknesses suggest a need for more research on IIPTs for children.

Maintaining Lasting Improvements: One-Year Follow-Up of Children With Severe Chronic Pain Undergoing Multimodal Inpatient Treatment

OBJECTIVE To investigate the long-term effectiveness of a 3-week multimodal inpatient program for children and adolescents with chronic pain. METHODS 167 adolescents were evaluated at pretreatment baseline, 3-, and 12-month follow-up. Long-term effectiveness was investigated for pain-related variables (pain-related disability, school absence, pain intensity) and emotional distress. RESULTS We found statistically and clinically significant changes in all variables. After 1 year, the majority (56%) showed overall improvement as indexed by decreased pain-related disability or school absence. 22% had an unsuccessful treatment outcome. Those showing only short-term improvements had higher levels of emotional distress at baseline. CONCLUSIONS 1 year after completing a multimodal inpatient program adolescents report less chronic pain, disability, and emotional distress. Clinically significant changes remain stable. Adolescents with high levels of emotional distress at admission may require special attention to maintain positive treatment outcomes. Specialized inpatient therapy is effective for children with chronic pain.

Childhood diabetic neuropathy: functional impairment and non‐invasive screening assessment

Aim  Sensory diabetic neuropathy, determined by nerve conduction studies, is common in children with Type 1 diabetes. Diabetic neuropathy diagnoses are rarely made in paediatric daily care because they are asymptomatic, vibration detection is mostly normal and nerve‐conduction testing is impractical. The present study aims to: (1) describe somatosensory dysfunction in children with diabetes, (2) test whether diabetes duration and HbA1c are related to somatosensory dysfunction and (3) identify the best screening test for large‐fibre dysfunction, as indicated by nerve conduction studies.

Interference and facilitation in overt speech production investigated with event-related potentials

We report an event-related potential study investigating the neural basis of interference and facilitation in the picture-word interference paradigm with immediate overt naming. We used the high temporal resolution of the electrophysiological response to dissociate general and specific interference processes, by comparing unrelated word distractors to nonlinguistic (a row of Xs), surface feature denoting, and category member distractors. Our results first indicate that the increased naming latencies for linguistic relative to nonlinguistic distractors are because of general conflict-monitoring processes, associated with early event-related potential effects (120–220 ms) and increased activity in the anterior cingulate cortex. Next, distractors specifying a surface feature of the picture seem to facilitate its identification within the same time window, which involves widespread networks. Finally, nonlinguistic and surface feature distractors also reduced the N400 amplitude, relative to unrelated word distractors. Taken together our results support the view that several distinct processes give rise to the reaction time results often observed in picture naming.

Developmental and sex differences in somatosensory perception—a systematic comparison of 7- versus 14-year-olds using quantitative sensory testing

Summary Quantitative sensory testing in 7‐ and 14‐year‐olds based on a priori sample size calculations revealed higher pain sensitivity in 7‐year‐olds, but no sex‐related differences and similar detection thresholds. ABSTRACT There are controversial discussions regarding developmental‐ and sex‐related differences in somatosensory perception, which were found, eg, when comparing younger children (6–8 years), older children (9–12 years), and adolescents (13–16 years) using quantitative sensory testing (QST). The aim of our current study was to systematically assess the impact of age and sex using the QST protocol of the German Research Network on Neuropathic Pain (DFNS). QST, including thermal and mechanical detection and pain thresholds, was assessed in 86 healthy 7‐year‐old children (42 girls and 44 boys) and 87 healthy 14‐year‐old adolescents (43 girls and 44 boys). The sample size was calculated a priori to detect medium‐sized effects as found in the previous studies with adequate power. Developmental and sex differences were tested using univariate analysis of variance. Children were more sensitive to most pain stimuli, except cold pain stimuli, compared with adolescents, but did not differ in mechanical and thermal detection thresholds except in regard to cold stimuli. Sex had an impact only on warm detection, with girls being more sensitive. There were no interactions between age and sex. In conclusion, developmental changes during the puberty appear to influence pain perception, whereas sex effects in childhood are negligible. At present, it is not clear what brings about the differences between adult men and women that are apparent in epidemiological studies. Our results contradict the hypothesis that differences in peripheral nerve‐fiber functioning underlie sex effects.

Cut points for mild, moderate, and severe pain on the VAS for children and adolescents: What can be learned from 10 million ANOVAs?

Summary Estimating the variability of optimal cut points for mild, moderate, and severe pain reveals that the same set of cut points for the VAS can be used for adolescents’ pain‐intensity ratings as for parental ratings of their children’s pain. Abstract Cut points that classify pain intensity into mild, moderate, and severe levels are widely used in pain research and clinical practice. At present, there are no agreed‐upon cut points for the visual analog scale (VAS) in pediatric samples. We applied a method based on Serlin and colleagues’ procedure (Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. PAIN® 1995;61:277–84) that was previously only used for the 0 to 10 numerical rating scale to empirically establish optimal cut points (OCs) for the VAS and used bootstrapping to estimate the variability of these thresholds. We analyzed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study and defined OCs both for parental ratings of their children’s pain and adolescents’ self‐ratings of pain intensity. Data from 2276 children (3 to 10 years; 54% female) and 2982 adolescents (11 to 17 years; 61% female) were analyzed. OCs were determined in a by‐millimeter analysis that tested all possible 4851 OC combinations, and a truncated analysis were OCs were spaced 5 mm apart, resulting in 171 OC combinations. The OC method identified 2 different OCs for parental ratings and self‐report, both in the by‐millimeter and truncated analyses. When we estimated the variability of the by‐millimeter analysis, we found that the specific OCs were only found in 11% of the samples. The truncated analysis revealed, however, that cut points of 35:60 are identified as optimal in both samples and are a viable alternative to separate cut points. We found a set of cut points that can be used both parental ratings of their children’s pain and self‐reports for adolescents. Adopting these cut points greatly enhances the comparability of trials. We call for more systematic assessment of diagnostic procedures in pain research.

Classifying the severity of paediatric chronic pain - an application of the chronic pain grading

The chronic pain grading (CPG), a standard approach to classify the severity of pain conditions in adults, combines the characteristics of pain intensity and pain‐related disability. However, in children and adolescents, the CPG has only been validated in a school sample, but not in the actual target population, i.e., clinical populations with pain.

Development of Somatosensory Perception in Children: A Longitudinal QST-Study

Cross-sectional studies on somatosensory perception in children demonstrate lower pain thresholds for children compared with adolescents. The aim of the present longitudinal study was to replicate these age-related differences in a longitudinal design. Total 38 children and adolescents aged 6 to 16 years (two girls and two boys within each year) participated in this study. Quantitative sensory testing (QST) according to the protocol of the German research network on neuropathic pain (DFNS) was assessed twice with an interval of 15.8 ± 3.0 months. Bland-Altman analyses describe the short-term reliability of the measurements. Intraindividual sensory development was measured using paired t-test and quantified by effect sizes Cohens d between the two measurements. QST parameters showed good short-term reliability. Over a period of 1 year, children became less sensitive to painful stimuli, especially to cold pain, pressure pain, and mechanical pain. No systematic developmental changes were observed in response to the other somatosensory stimuli. QST is reliable over short retest intervals. In line with previous results from cross-sectional studies, we find a decrease in pain sensitivity with increasing age but no differences in nonnociceptive somatosensory processing over a period of 1 year in children between 6 and 16 years of age. Taken together, these results highlight the importance of a reference-based interpretation of the individual QST data.