Katherine M. Kitzmann

Family-based interventions for pediatric obesity: methodological and conceptual challenges from family psychology.

Family-based interventions for pediatric obesity are defined by active parent involvement in treatment. In the current review the authors examine 31 family-based interventions with published outcome data and distinguish 4 categories of family-based interventions: (a) Target a narrow range of parent behaviors related to eating/exercise and assess change only in terms of child eating, exercise, or weight; (b) target a similarly narrow range of parent behaviors but nevertheless assess program-related changes in general parenting skills or family functioning; (c) target a broad range of parent behaviors related to general parenting and family functioning but do not assess program-related changes in these areas; and (d) target general parenting or family functioning and also assess program-related changes in these areas. The authors highlight methodological and conceptual challenges facing researchers in this area and argue for an even broader family focus in family-based interventions for pediatric obesity.

Are Only Children Missing Out? Comparison of the Peer-Related Social Competence of Only Children and Siblings

In this study, we tested the assumption that having a sibling provides practice with skills that generalize to peer relations, by comparing the peer-related social competence of only children, first-borns with one sibling, and second-borns with one sibling in a sample of 139 elementary school-age children. Only children were similar to classmates in terms of number of close friendships and friendship quality, but were less liked by classmates as a group. Only children were more likely both to be victimized and aggressive in the peer group, suggesting that having a sibling may be especially helpful for learning to manage conflict. Results are discussed in terms of the need to examine multiple levels of social complexity to understand family-peer links.

Parent–child relationships and insulin-dependent diabetes mellitus: Observational ratings of clinically relevant dimensions.

An observational measure of parent-child relationships was developed based in family systems theory and used to predict the management of insulin-dependent diabetes mellitus (IDDM). The new measure reliably assessed interactions between 74 parents and their school-age and adolescent children with IDDM in this multitrait, multimethod study. The observational measure predicted both ratings of adherence to treatment and biological indices of metabolic control (glycosylated hemoglobin). Diabetes was better maintained in children whose parents were more emotionally supportive, had better resolved their grief about their childs diabetes, were less sad and angry, and in parent-child dyads were better able to resolve conflicts.

External Validity Reporting in Behavioral Treatment of Childhood Obesity

CONTEXT To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity. EVIDENCE ACQUISITION Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2-18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors. EVIDENCE SYNTHESIS 1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%-100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability. CONCLUSIONS Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.

Child Characteristics as Moderators of the Association Between Family Stress and Children's Internalizing, Externalizing, and Peer Rejection

We examined child characteristics of coping strategies, age, and gender as moderators of the association between family stressors and internalizing, externalizing, and peer rejection in a sample of 228 3rd–5th grade children. Consistent with previous research, children in the current study who experienced a higher number of family stressors were significantly less well-accepted by classmates. This association was not moderated by childrens coping strategies or child age. Child gender did moderate the association between family stressors and internalizing behavior. Specifically, as the number of stressors increased, internalizing behavior decreased among girls, but not boys. The results are discussed in terms of the role of child variables in explaining the variability in childrens responses to family stress.

Parents’ Versus Children’s Perceptions of Interparental Conflict as Predictors of Children’s Friendship Quality:

Grych and Fincham’s (1990) cognitive-contextual model highlights children’s perceptions as potential influences on the extent to which interparental conflict is associated with negative child outcomes. We asked children (n= 40, age 8–12 years), mothers, and fathers to report on multiple dimensions of interparental conflict. As predicted, family members showed greater correspondence in their ratings of the overt properties of conflict than in their ratings of children’s subjective distress in response to the conflict. Compared with parents’ perceptions, children’s perceptions of interparental conflict showed stronger and more consistent associations with multiple dimensions of friendship quality. The results provide further evidence of the utility of assessing children’s perceptions of marital conflict, rather than relying solely on parents’ reports.

An Experimental Analysis of Children's Dislike of Aggressors and Victims

We experimentally examined social contextual factors that might moderate childrens dislike for aggressors and for victims of aggression, by varying both the aggressors behavior (aggressive toward multiple children versus aggressive only toward one child) and the victims behavior (passive versus assertive). Children (117 male and female fourth to sixth graders) listened to one of four scenarios describing the experiences of boys at a summer camp and rated how much they liked the aggressor, the victim, and the other children in the scenario; children also reported how much they thought the aggressor, victim, and others liked each other. Overall, and consistent with previous research, children disliked aggressors the most, followed by victims and then by the other children in the scenarios. Importantly, childrens liking was influenced by the social context in which the aggression occurred, particularly in regards to how the victim responded. Aggressors (general or focused) were liked more if their victim was assertive rather than nonassertive. Furthermore, children liked nonassertive victims less than assertive victims, particularly a nonassertive victim in response to a general aggressor. Inferred liking among the group members also was dependent on the social context of the provocation. This research highlights the need to consider aggression as more than a set of behaviors. Aggression is a social event embedded within a social context and interpersonal relationships must be considered.

Exploratory factor analysis: health perceptions of Chinese early childhood educators in Hong Kong

The aim of this study was to explore health perceptions of preschool teachers, with a view to inform early childhood practices and teacher education. Pre-service student-teachers and in-service teachers (n = 200) who were voluntarily recruited completed a 24-item health attitude questionnaire. Factor analysis identified four dimensions of health attitudes, reflecting physical, psychosocial, mental and emotional domains. Inter-correlations among the factors suggested that early childhood educators in Hong Kong embrace a holistic view of health, although they consider physical and emotional health as more salient than the psychosocial and mental health dimensions. In comparisons of the perceptions of in-service teachers and student-teachers, students placed less emphasis on psychosocial health, but teachers placed more emphasis on physical health. The findings are discussed in terms of their implications for designing health education programmes for preschool teacher education.

Family Stress and Children's Rejection by Peers: Do Siblings Provide a Buffer?

We present two studies examining the role of siblings as possible buffers against the negative impact of family stress on childrens peer relations. In Study 1, we examined associations between stress, sibling status, and peer rejection in a sample of 206 children in grades 3–5 in a majority African-American, rural, lower SES sample. In this low-income sample, higher stress was associated with more peer rejection, but having a sibling did not appear to buffer children against rejection by peers. In Study 1, we examined associations between stress, sibling status, and multiple dimensions of peer relations in a sample of 47 children in grades 3–6 in a majority Caucasian, urban, middle SES sample. In this middle-class sample, stress was unrelated to peer rejection but was associated with higher aggression, which often leads to rejection. In addition, the results from the middle class sample suggested that having a sibling may act as a buffer under high-stress conditions. The results are discussed in terms of current conceptualizations of buffering, contextual influences on family–peer links, and the need to assess multiple dimensions of childrens peer-related functioning.

A Preliminary Investigation of Stimulus Control, Self-Monitoring, and Reinforcement in Lifestyle Interventions for Pediatric Overweight

Objective. The current study examined the use of stimulus control, self-monitoring, and reinforcement by youth, parents, and interventionists as related to weight management in lifestyle intervention programs. Design. Secondary analysis of an existing data set was used to integrate the results of 14 published, randomized treatment–control intervention trials for overweight youth aged 2 to 18 years. Main outcome measure. Between-group differences in weight-related outcomes, including weight, body mass index (BMI), and percentage overweight, measured at the end of treatment, were used to calculate effect sizes for each treatment–control comparison. Additionally, average effect sizes were calculated among sets of comparisons sharing similar approaches to implementing behavioral techniques. Results. Treatment programs that taught youth to use stimulus control, taught youth to self-monitor, and taught parents to use reinforcement, produced significantly larger effect sizes than programs that did not include these components. The beneficial effects of these specific behavioral techniques appeared to be amplified when used with multiple key individuals. Conclusion. This initial study quantitatively demonstrated significant benefits associated with teaching youth stimulus control and self-monitoring, and teaching parents reinforcement to shape health behaviors in lifestyle interventions for pediatric overweight. Furthermore, teaching youth and parents the same techniques may contribute to better weight-related outcomes. These findings and descriptive information on how techniques were described, taught, and delivered may guide future research efforts aimed at identifying and examining the most effective behavioral components to include in brief interventions.