Jennifer Reiter-Purtill

Controlled Study of Critical Parent and Family Factors in the Obesigenic Environment

Objective: Critical gaps remain in our understanding of the obesigenic family environment. This study examines parent and family characteristics among obese youth presenting for treatment in a clinic setting.

Negative Peer Perceptions of Obese Children in the Classroom Environment

Objective: It is asserted that the more immediate and observable consequences of pediatric obesity are psychosocial in nature. This study examines the peer relations of clinically referred obese youth compared to demographically comparable nonoverweight peers within the classroom environment.

Social, emotional, and behavioral functioning of children with NF1

Children with neurofibromatosis type 1 (NF1) can have varying degrees of cognitive impairment, and are at risk for social, emotional, and behavioral dysfunction. We undertook an evaluation of social, emotional, and behavioral functioning of youth with NF1 and peers from multiple perspectives. We hypothesized that children with NF1 would have more psychosocial difficulties, which would be positively associated with neurological involvement. We compared 58 children with NF1, ages 7–15, with comparison classroom peers, classmates who were same race/gender and closest date of birth. Peer relationships, emotional well‐being, and behavior were evaluated from multiple perspectives in multiple settings. Results showed that teachers perceived children with NF1 as more prosocial (i.e., polite, helpful to others). Teachers and peers viewed children with NF1 as displaying less leadership behavior and as more socially sensitive‐isolated (i.e., often left out, trouble making friends). Children with NF1 had fewer friendships and were less well liked by peers. Mothers and fathers reported more problems with social functioning among children with NF1. Few group differences in emotional well‐being and behavior were identified according to child and father report. However, mothers perceived children with NF1 to have more emotional problems relative to comparison peers, predominantly among older children. Neurological involvement was significantly related to psychosocial problems. We conclude that children with NF1 are frequently socially isolated and rejected by peers; and that greater neurological involvement is associated with more emotional problems. Central nervous system involvement appears to play a key role in identifying children at risk for problems with friendships, social acceptance, and emotional functioning (i.e., depression).

Risk-Taking Behaviors of Adolescents With Extreme Obesity: Normative or Not?

OBJECTIVE: Present first published data detailing high-risk behaviors of adolescent high school students (HSS) with extreme obesity (BMI ≥ 99th percentile for age and gender) compared with healthy weight peers (5th–84th percentile). METHODS: The 2007 Youth Risk Behavior Survey was used to compare HSS with extreme obesity (N = 410) and healthy weight peers (N = 8669) in their engagement in (1) tobacco use, (2) alcohol/other drug use, (3) high-risk sexual behaviors, and (4) suicidal behaviors. Logistic regression was used to calculate gender-stratified odds ratios (OR) and 95% confidence intervals (CI), controlling for age and race. RESULTS: HSS with extreme obesity were similar to healthy weight peers in the prevalence of most behaviors related to alcohol/drug use, high-risk sexual activities, and suicide, with the following exceptions: relative to healthy weight HSS, both male and female students with extreme obesity more frequently reported ever trying cigarettes (female students, adjusted OR: 2.0 [95% CI: 1.3–3.2]; male students, OR: 1.5 [CI: 1.2–2.0]). Compared with healthy weight female students, female students with extreme obesity had lower odds of ever having sex (OR: 0.5 [CI: 0.3–0.9]), but greater odds of drinking alcohol/using drugs before their last sexual encounter (OR: 4.6 [CI: 1.2–17.6]), currently smoking (OR: 2.3 [CI: 1.2–4.4]), and using smokeless tobacco (OR: 4.6 [CI: 1.2–17.2]). Compared with healthy weight male students, male students with extreme obesity had greater odds of smoking before age 13 (OR: 1.4 [CI: 1.0–2.0]). CONCLUSIONS: With few exceptions, HSS with extreme obesity engage in high-risk behaviors at rates comparable with healthy weight peers, sometimes in even more dangerous ways. Health care providers should assess risk-taking behaviors in this cohort.

A controlled longitudinal study of the social functioning of children who completed treatment of cancer.

Background A follow-up assessment of social functioning was performed for children with cancer after completion of treatment. It was hypothesized that children who completed cancer treatment (CCT) would have more social problems than their peers who were not chronically ill (COMP) and that greater treatment intensity would be predictive of increasing social difficulties over time. Patients and Methods Peer, teacher, and self-reports of social functioning were obtained from 69 CCTs and 77 COMPs. Social reputation and social acceptance were evaluated cross-sectionally and longitudinally. Results Relative to COMPs, CCTs described themselves as more prosocial, were perceived by teachers as less aggressive, and were seen by peers as more sick, more tired, and as missing more school. Longitudinal analyses indicated that self-reported prosocial scores were significantly more stable over time for CCTs relative to COMPs. Children who received more intense treatment were perceived by peers as more prosocial and less aggressive, but as having fewer best friends 2 years after treatment ended. Conclusions CCTs had minimal impact on their social functioning as a result of their experience with cancer for those children who have returned to school. These results suggest that routine interventions with regard to social functioning after treatment ends may not be warranted for most CCTs when an integrated program of psychosocial services coordinated by mental health professionals has been provided during treatment. However, children who have undergone especially intense treatment may be at some risk for social problems.

Peer Relationships and Emotional Well-Being of Children with Sickle Cell Disease: A Controlled Replication

We completed a replication study examining the social and emotional functioning of children with sickle cell disease (SCD) who have not had an overt stroke and a group of demographically similar comparison classmates based upon data from multiple informants. Relative to comparison peers, children with SCD were described by teachers as more prosocial and less aggressive. Peers described them as having fewer friends, less athletic, ill more often, and missing more school. No group differences were identified for emotional well-being. Effect size analyses indicated that this study replicated a number of findings from our previous study of children with SCD (Noll et al., 1996). Findings from both studies suggest relative psychological hardiness among children with SCD who have not had an overt stroke.

Adolescent suicidal behavior across the excess weight status spectrum.

Relative suicidal behavioral risks (ideation, attempts) for overweight, obese, and extremely obese adolescents (vs. healthy weight) and who did/did not accurately perceive themselves as overweight were examined in this study.

Temperament and Peer Acceptance The Mediating Role of Social Behavior

This study examined whether children’s social behavior mediated the associations between specific dimensions of temperament and peer acceptance, and whether these associations were moderated by gender. We also explored the role of child’s age on the associations between temperament and social functioning. Primary caregiver reports of temperament and peer reports of social behavior and peer acceptance were obtained for 140 boys and 135 girls (8–16 years, M = 11.9) from 275 different classrooms. Dimensions of temperament reflecting general activity, flexibility-rigidity, and attentional focus were found to be particularly important to children’s social functioning at school, and their associations with peer acceptance were found to be significantly mediated by social behaviors. Additionally, we found that while linkages between dimensions of temperament and social acceptance were present for boys and girls, the pathways (mediators) were often different. Our exploratory analyses suggested that linkages between temperament and social functioning are strong for younger children, but less so for older youth. Findings are discussed in the context of their implications for theory and clinical applications, emphasizing the importance of considering gender differences in the contributions of temperament to social functioning.

Adolescent bariatric surgery: caregiver and family functioning across the first postoperative year

BACKGROUND The present study examined the psychological distress, parenting stress, and family functioning in female caregivers of adolescents undergoing bariatric surgery compared to that of caregivers of adolescents with extreme obesity not undergoing surgery across the first postoperative year. METHODS The female caregivers of 16 adolescents undergoing Roux-en-Y gastric bypass (mean age 16.6 years, mean body mass index 66.2 kg/m(2); 94% recruitment) and those of 28 comparison adolescents who had sought behavioral weight management (mean age 16.2 years, mean body mass index 46.3 kg/m(2); 90% recruitment) were included in the study. The caregivers completed measures of psychological distress (Symptom Checklist-90-Revised), parenting stress (Stress Index for Parents of Adolescents), and family functioning (Family Assessment Device) at baseline (before surgery) and at 6 and 12 months after surgery. Caregiver and adolescent anthropometric data were also obtained. RESULTS At baseline, clinical cutoffs were exceeded by 29.5% of the caregivers for psychological distress, 31.8% for family dysfunction, and 13.2% for parenting stress. Linear mixed modeling indicated that bariatric adolescents had a significantly greater body mass index at baseline than the comparison adolescents (t = -7.79, P <.001), with a substantial reduction by 12 months relative to the near-flat trajectory of the comparison group (t = 20.32, P <.001). No significant group differences at baseline or group trajectory differences were identified for any caregiver or family variable. CONCLUSION Our initial findings suggest that caregivers of adolescents with extreme obesity present with limited dysfunction and that bariatric surgery has no effect on caregiver distress, parenting stress, or family functioning across the first postoperative year. Larger samples and longer term follow-up will allow examination of what role caregiver/family factors play in the adolescent postoperative outcomes.

A controlled, longitudinal study of the social functioning of youth with sickle cell disease.

OBJECTIVE: To assess the peer relationships of adolescents with sickle cell disease (SCD) and demographically similar comparison peers who did not have a chronic illness 2 years after an initial evaluation. As a result of ongoing medical challenges associated with SCD and the psychological demands of adolescence, we hypothesized that children with SCD would be viewed by peers as more sensitive and isolated, they would have fewer friends, and they would be less well liked than comparison peers. PATIENTS AND METHODS: At follow-up, peer (n = 2067) and teacher (n = 120) reports of social functioning were obtained for 60 children with SCD and 66 comparison peers. Social reputation (What is the child like?) and social acceptance (Is the child liked?) were evaluated cross-sectionally and longitudinally at the 2-year follow-up (ages 10–17). RESULTS: Relative to comparison peers, children with SCD were perceived as less aggressive by peers and teachers. No significant differences were found between groups on measures of friendship or social acceptance. Results of longitudinal analyses indicated that teacher-reported levels of sensitive and isolated behavior increased over time for comparison peers but remained stable for children with SCD. CONCLUSIONS: In general, the social functioning of children with SCD remained stable over time and was not suggestive of emergent social dysfunction. Findings are discussed within a developmental psychopathology framework, possible protective effect of SCD for youth from high-risk environments, and implications regarding pain management for these youth.