Jennifer L. Lee

Behavioral laterality in captive bonobos (Pan paniscus).

Behavioral laterality was studied in a captive group of 11 bonobos (Pan paniscus). In an observational method a significant left lateral bias in carrying and a right lateral bias in leading limb were found. Direction of lateral bias in carrying and leading limb was enhanced when subjects maintained a bipedal posture. Analysis of bimanual feeding behavior revealed a significant right-hand bias for eating when subjects were holding food with their left hand. In an experimental method a significant shift toward greater right-hand use was found when subjects were required to maintain a bipedal, rather than a quadrupedal, posture. There was no evidence of lateral bias for measures of face touching, self-touching, or gestures. The results are discussed in the context of previous reports of primate laterality.

Emotional Functioning, Barriers, and Medication Adherence in Pediatric Transplant Recipients

OBJECTIVE This study assessed relationships among internalizing symptoms, barriers to medication adherence, and medication adherence in adolescents with solid organ transplants. METHOD The sample included 72 adolescents who had received solid organ transplants. Multiple mediator models were tested via bootstrapping methods. RESULTS Bivariate correlations revealed significant relationships between barriers and internalizing symptoms of depression, anxiety, and posttraumatic stress, as well as between internalizing symptoms and medication adherence. Barriers indicative of adaptation to the medication regimen (e.g., forgetting, lack of organization) were related to medication adherence and mediated the relationship between internalizing symptoms and medication adherence. CONCLUSIONS These findings indicate that barriers may serve as a more specific factor in the relationship between more general, pervasive internalizing symptoms and medication adherence. Results may help guide areas for clinical assessment, and the focus of interventions for adolescent transplant recipients who are experiencing internalizing symptoms and/or who are nonadherent to their medication regimen.

Systematic and Meta-Analytic Review: Medication Adherence Among Pediatric Patients With Sickle Cell Disease

OBJECTIVE To provide a comprehensive summary (systematic review) of medication adherence rates by assessment method and medication type for pediatric patients with sickle cell disease (SCD), as well as identify important correlates for future research. METHODS Articles assessing medication adherence and published between 1982 and February 2015 (n = 49) were identified using electronic databases. A meta-analysis of 14 studies examining demographic, medical, and psychosocial factors and medication adherence was conducted. RESULTS Adherence rates ranged from 12% to 100% across all medications. Approximately 30% of studies reported associations between adherence and key demographic, medical, and psychosocial correlates. Mean effect sizes were small to moderate (r = .02-.53). CONCLUSIONS The wide range of adherence rates reported in the literature may be because of, in part, the use of variable assessment strategies. Future studies examining pediatric SCD adherence should incorporate key correlates with the goal of replication.

Health-related quality of life and psychosocial functioning in children with Tourette syndrome: parent-child agreement and comparison to healthy norms.

This study aimed to evaluate the degree of agreement between parent proxy- and child self-report on measures of child psychosocial functioning and health-related quality of life in children with Tourette syndrome. Participants included 28 children with Tourette syndrome and their parents. All participants provided ratings of children’s level of quality of life and psychosocial functioning. Results revealed strong, positive relationships between child self- and parent proxy-reports on all quality of life and psychosocial functioning domains. Parents perceived significantly higher levels of depression compared to their children, whereas children reported significantly lower Physical quality of life compared to their parents. Results suggest that assessment of quality of life and psychosocial functioning should include multiple reporters whenever feasible. Caution should be used when exclusively relying on parent proxy-reports of quality of life and psychosocial functioning, as these reports may not accurately reflect children’s difficulties or perceptions of their functioning.

Executive Functioning, Barriers to Adherence, and Nonadherence in Adolescent and Young Adult Transplant Recipients

OBJECTIVE : To evaluate levels of executive functioning in a sample of adolescent and young adult (AYA) transplant recipients, and to examine executive functioning in association with barriers to adherence and medication nonadherence.  METHOD : In all, 41 caregivers and 39 AYAs were administered self- and proxy-report measures.  RESULTS : AYA transplant recipients have significant impairments in executive functioning abilities. Greater dysfunction in specific domains of executive functioning was significantly associated with more barriers to adherence and greater medication nonadherence.  CONCLUSION : AYA transplant recipients are at increased risk for executive dysfunction. The assessment of executive functioning abilities may guide intervention efforts designed to decrease barriers to adherence and promote developmentally appropriate levels of treatment responsibility.

Factors Associated With Healthcare Utilization Among Children With Noncardiac Chest Pain and Innocent Heart Murmurs

OBJECTIVE To examine differences in factors related to health care utilization (HCU) among children eventually diagnosed with noncardiac chest pain (NCCP) or an innocent heart murmur (IHM). METHODS 67 pediatric patients with NCCP and 62 with IHM and their parent/guardian completed paper-and-pencil measures of psychological functioning and past HCU during an initial visit to the cardiologists office. RESULTS Children with NCCP utilized significantly more health care services compared to their IHM counterparts in the year prior to their cardiology visit. Children in the NCCP group had higher internalizing and somatic symptoms, and their parents experienced more anxious symptoms, than those in the IHM group. For the NCCP group only, child and parent psychological symptoms and parent HCU were positively related to child HCU. CONCLUSIONS Results identify possible child and parent psychological factors that may be the focus of interventions to reduce high rates of HCU among children with NCCP.

Family Functioning and Depressive Symptoms in Adolescent and Young Adult Cancer Survivors and Their Families: A Dyadic Analytic Approach

Objective To examine dyadic relationships between depressive symptoms and family functioning in families of pediatric cancer survivors. Methods Sixty-four adolescent and young adult (AYA) cancer survivors and their caregivers self-reported on depressive symptoms and family functioning. Multilevel modeling analyses were used to test actor–partner interdependence models. Results Significant actor effects of depressive symptoms on domains of family functioning were found for AYAs and their caregivers. Only caregivers’ depressive symptoms exerted a significant effect on AYAs’ report of family cohesion, indicating the presence of significant partner effects for AYAs. Conclusions AYAs’ and caregivers’ depressive symptoms are related to poorer family functioning. Caregivers’ perceptions of depressive symptoms relate not only to their own perceptions of family functioning but also to that of their children. These findings begin to map the complex relationships that exist between AYAs and their caregivers and elucidate some of the mechanisms through which caregiver-related variables affect AYA outcomes.

Health Care Utilization and Psychosocial Factors in Pediatric Noncardiac Chest Pain

OBJECTIVE This study investigated factors related to health care utilization (HCU) among patients presenting to pediatric cardiologists with symptoms of chest pain later diagnosed as noncardiac chest pain (NCCP). METHODS Participants included 67 children and adolescents diagnosed with NCCP and their parent. Measures of HCU, pain severity, and child self-report and parent self-report of anxiety and depression were collected at the cardiologists office. The childs sex was examined as a moderator of HCU. RESULTS Pain severity and maternal and child depression were significant contributors to the variance in child HCU. The relationship between depression and HCU was moderated by the childs sex, with boys higher in levels of maternal or child depression reporting greater HCU. CONCLUSIONS Psychological factors are related to HCU for children with NCCP, with depression positively associated with HCU. The childs sex plays an important role in depression and HCU. Family-focused psychological screening of pediatric patients with NCCP may aid in identifying families who may benefit from referrals for psychological assessment and treatment.

Clinical Cutoffs for Adherence Barriers in Solid Organ Transplant Recipients: How Many Is Too Many?

OBJECTIVE The current study used multiple statistical methods to determine empirically derived and clinically relevant cutoff scores on the Adolescent Medication Barriers Scale (AMBS) and Parent Medication Barriers Scale (PMBS) to detect adolescents and young adults with solid organ transplants who experienced medication nonadherence or negative medical outcomes. METHODS Participants included 71 patients and 80 caregivers. Cutoff scores were determined via receiver operating characteristic curve analyses, t-test analyses, and the sensitivity and specificity of using certain cutoff scores. RESULTS AMBS scores of ≥3 barriers and PMBS scores of ≥2 barriers were determined as the ideal cutoffs for identifying patients meeting criteria for the outcome variables. CONCLUSIONS Clinicians should consider using these recommended cutoff scores when assessing adherence barriers in adolescents and young adults with solid organ transplants and their families. Patients or caregivers endorsing barriers above the cutoffs may benefit from further assessment or intervention to address barriers, nonadherence, or related medical issues.

Internalizing Symptoms and Functional Disability in Children With Noncardiac Chest Pain and Innocent Heart Murmurs

OBJECTIVE To examine the occurrence of internalizing symptoms and functional disability in children with noncardiac chest pain (NCCP) compared with children with innocent heart murmurs (IHMs). METHOD 67 children with NCCP (M [SD] age = 12.61 [2.63]; 68.7% Caucasian) and 62 children with IHM (M [SD] age = 12.67 [2.62]; 50% Caucasian) were recruited from pediatric cardiology offices. Children and parents completed measures of psychological functioning and functional disability during a first visit to the cardiologist before diagnosis. RESULTS Children with NCCP reported greater levels of anxiety, depression, and anxiety sensitivity than children with IHM. Children with NCCP and their parents reported greater levels of functional disability and somatization than children with IHM and their parents. CONCLUSION Children with NCCP experience greater levels of psychosocial distress and impairment than similarly physically healthy children with IHM. Consideration of psychosocial influences on NCCP would likely be beneficial in aiding assessment and treatment.