Jodi L. Kamps

The PedsQL™ in Pediatric Asthma: Reliability and Validity of the Pediatric Quality of Life Inventory™ Generic Core Scales and Asthma Module

The PedsQL™ is a modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents ages 2–18. The PedsQL™ 4.0 Generic Core Scales were developed to be integrated with the PedsQL™ Disease-Specific Modules. The PedsQL™ 3.0 Asthma Module was designed to measure pediatric asthma-specific HRQOL. The PedsQL™ was administered to 529 families. Internal consistency reliability was demonstrated for the PedsQL™ 4.0 Total Score (α = 0.90 child, 0.91 parent report) and Asthma Module (average α = 0.71 child, 0.86 parent report). The PedsQL™ 4.0 distinguished between healthy children and children with asthma. The validity of the PedsQL™ Asthma Module was demonstrated through intercorrelations with a previously standardized asthma disease- specific instrument. Responsiveness was demonstrated through patient change over time as a result of clinical intervention. The results demonstrate the reliability, validity, and responsiveness of the PedsQL™ required for an outcome measure in pediatric asthma clinical trials and research.

Racial Disparity in A1C Independent of Mean Blood Glucose in Children With Type 1 Diabetes

OBJECTIVE Mean blood glucose (MBG) and MBG-independent factors both influence A1C levels. Race was related to A1C independent of MBG in adults. The goal of this study was to determine if racial disparity exists in A1C independent of MBG in children with diabetes. RESEARCH DESIGN AND METHODS Participants included 276 children with type 1 diabetes. A1C and MBG were obtained from multiple clinic visits, and a hemoglobin glycation index (HGI) (an assessment of A1C levels independent of MBG) was calculated. A1C and HGI were analyzed controlling for age, diabetes duration, and MBG. RESULTS African Americans had statistically significantly higher A1C (9.1 ± 0.1) and HGI (0.64 ± 0.11) than Caucasians (A1C 8.3 ± 0.1, HGI −0.15 ± 0.07) independent of covariates. CONCLUSIONS Because of racial disparity in A1C, which is independent of MBG, we recommend that A1C and MBG be used together to make therapeutic decisions for children with diabetes.

Improving Adherence to Inhaled Corticosteroids in Children With Asthma: A Pilot of a Randomized Clinical Trial

This study examined the efficacy of an educational and behavioral intervention designed to improve adherence to inhaled corticosteroids in children with asthma. Fifteen children and their caregivers were randomly assigned to either a targeted educational and behavioral intervention (treatment group) or a broader psychoeducational condition (comparison group). Given the small sample size, data were analyzed using pooled time series analysis (PTSA), a unique statistical methodology that treats observations for each participant as a separate case and provides statistical power in small samples. Participants in the treatment group showed significant improvements in adherence (16.38%) during the intervention. Participants in both groups also made clinically meaningful improvements in pulmonary function. This study addressed various limitations of previous intervention research and demonstrated that a targeted intervention including educational and behavioral components was effective in improving adherence to inhaled corticosteroids in children with asthma. Implications for adherence interventions are discussed.

Psychosocial Issues That Affect Youth with Diabetes

Abstract Type 1 diabetes, one of the most common diseases of childhood, requires adherence to a complicated regimen which is often times difficult to manage resulting in stress for children, siblings, and caregivers. Many children with diabetes are nonadherent, likely due to the difficulty and complexity of the tasks required, and, thus, are at greater risk for diabetes related complications. For health care educators, it is important to understand the various psychosocial issues that affect adherence and adjustment to diabetes. This article will discuss these issues, including coping with a new diagnosis, school factors, regimen adherence and family variable and parenting strategies. Recommendations for health care educators are also discussed.

Age and Adaptive Functioning in Children and Adolescents with ASD: The Effects of Intellectual Functioning and ASD Symptom Severity.

The present study examined the moderating effects of intellectual functioning and ASD symptom severity on the relation between age and adaptive functioning in 220 youth with autism spectrum disorder (ASD). Regression analysis indicated that intellectual functioning and ASD symptom severity moderated the relation between age and adaptive functioning. For younger children with lower intellectual functioning, higher ASD symptom severity was associated with better adaptive functioning than that of those with lower ASD symptom severity. Similarly, for older children with higher intellectual functioning, higher ASD symptom severity was associated with better adaptive functioning than that of those with lower ASD symptom severity. Analyses by subscales suggest that this pattern is driven by the Conceptual subscale. Clinical and research implications are discussed.

A Pilot Study Examining the Effectiveness of the PEERS Program on Social Skills and Anxiety in Adolescents with Autism Spectrum Disorder

The Program for the Evaluation of the Enrichment of Relational Skills (PEERS), a social skills intervention for high functioning adolescents with autism spectrum disorder (ASD), has been proven efficacious in randomized control trials. However, the effectiveness of the PEERS program in community settings has not been studied. The present small-scale pilot study examined the effectiveness of the PEERS program in a community setting. Five adolescents and their caregivers participated in the PEERS intervention. Results indicated that the adolescents showed significant improvement in their social engagement, social cognition, social communication, social motivation, and knowledge of PEERS skills and concepts from pre- to post-intervention. Furthermore, adolescents showed significant reductions in their internalizing and autistic symptoms from pre- to post-intervention. The findings from this small-scale pilot study support the effectiveness of the PEERS program in community-based settings.

Hemoglobin A1c, frequency of glucose testing and social disadvantage: Metrics of racial health disparity in youth with type 1 diabetes

INTRODUCTIONnBlack youth with type 1 diabetes (T1D) have higher HbA1c than whites. To understand HbA1c differences, we examined the relationship of psycho-social factors and glucose testing with HbA1c.nnnMETHODSnGlucose tests per day (BGs/d) and mean blood glucose (MBG) were calculated from meter data of youth self-identified as black (nu202f=u202f33) or white (nu202f=u202f53) with T1D. HbA1c, family income, insurance status, concentrated disadvantage (CDI), psychological depression (DSC), mother educational attainment (MEA), and insulin delivery method (IDM) data was were analyzed.nnnRESULTSnBlack patients had significantly higher HbA1c, MBG and disadvantage measures compared to whites. BGs/d correlated with HbA1c, MBG, age and CDI. Race (pu202f<u202f0.0158), age (pu202f<u202f0.0001) and IDM (pu202f<u202f0.0036) accounted for 50% of the variability (R2u202f=u202f0.5, pu202f<u202f0.0001) in BGs/d. Regardless of age, black patients had lower BGs/d than whites. MBG (pu202f<u202f0.0001) and BGs/d (pu202f<u202f0.0001) accounted for 61% of the variance in HbA1c (pu202f<u202f0.0001).nnnCONCLUSIONSnBGs/d is easily assessed and closely associated with HbA1c racial disparity. BGs/d is intricately linked with greater social disadvantage. Innovative management approaches are needed to overcome obstacles to optimal outcomes.

Atypical PT anatomy in children with autism spectrum disorder with expressive language deficits

Deficits in communication are a core feature of autism spectrum disorder (ASD), however, structural language abilities are highly variable, ranging from minimally verbal to superior linguistic skills. Differences in the anatomy of cortical language regions, including anterior and posterior areas, have been found in ASD. It remains unclear, however, if anatomical differences distinguish individuals with impaired expressive language from those without such deficits. In addition, anatomical differences have not been explored in children with extremely low expressive language. This study included 34 boys with ASD, 7–11xa0years old, including an expressive language impaired group (nu2009=u200917) and an average-high language group (nu2009=u200917). The language impaired group was subdivided into a low (nu2009=u20099) and extremely low (nu2009=u20098) language subgroup for exploratory analyses to determine whether children with ASD with extremely low expressive language abilities exhibit distinct anatomy. Gray matter volume of the pars triangularis, pars opercularis, and planum temporale (PT) were measured on MRIs. PT volume was smaller in the ASD group with expressive language impairment relative to those without language deficits. The right PT volume was also positively correlated with language scores. The exploratory analyses revealed differences in the left PT, with smaller volume in the extremely low language subgroup, relative to the average and moderately low language groups. Results suggest that smaller PT volumes in both hemispheres are associated with severe language impairments in ASD. The PT may therefore, be a biomarker of language outcome in young children with ASD, with more studies of PT anatomy necessary.