Kiki Mastroyannopoulou

Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief.

&NA; A systematic review and subset meta‐analysis of published randomised controlled trials of psychological therapies for children and adolescents with chronic pain is reported. A search of four computerised abstracting services recovered 123 papers from which 28 potential trials were identified. Eighteen met the criteria for inclusion in the review. The majority of these papers reported brief behavioural and cognitive behavioural interventions for children with headache and many were conducted in community (i.e. school) settings. Meta‐analysis was applicable for 12 headache trials and one trial of recurrent abdominal pain using the Pain Index. The odds‐ratio for a 50% reduction in pain was 9.62 and the number needed to treat was 2.32, indicating that the psychological treatments examined are effective in reducing the pain of headache. The quality of the 18 trials retrieved is narratively reviewed and suggestions for the development of trials in this field are made.

Androgen insensitivity syndrome

Androgen insensitivity syndrome in its complete form is a disorder of hormone resistance characterised by a female phenotype in an individual with an XY karyotype and testes producing age-appropriate normal concentrations of androgens. Pathogenesis is the result of mutations in the X-linked androgen receptor gene, which encodes for the ligand-activated androgen receptor--a transcription factor and member of the nuclear receptor superfamily. This Seminar describes the clinical manifestations of androgen insensitivity syndrome from infancy to adulthood, reviews the mechanism of androgen action, and shows examples of how mutations of the androgen receptor gene cause the syndrome. Management of androgen insensitivity syndrome should be undertaken by a multidisciplinary team and include gonadectomy to avoid gonad tumours in later life, appropriate sex-hormone replacement at puberty and beyond, and an emphasis on openness in disclosure.

Clinical Validation of the Paediatric Pain Profile

The Paediatric Pain Profile (PPP) is a 20–item behaviour rating scale designed to assess pain in children with severe neurological disability. We assessed the validity and reliability of the scale in 140 children (76 females, mean age 9 years 11 months, SD 4 years 7 months; range 1 to 18 years), unable to communicate through speech or augmentative communication. Parents used the PPP to rate retrospectively their childs behaviour when‘at their best’and when in pain. To assess interrater reliability, two raters concurrently observed and individually rated each childs behaviour. To assess construct validity and responsiveness of the scale, behaviour of 41 children was rated before and for four hours after administration of an‘as required’analgesic. Behaviour of 30 children was rated before surgery and for five days after. Children had significantly higher scores when reported to have pain than‘at their best’and scores increased in line with global evaluations of pain. Internal consistency ranged from 0.75 to 0.89 (Cronbachs alpha) and interrater reliability from 0.74 to 0.89 (intraclass correlation). Sensitivity (1.00) and specificity (0.91) were optimized at a cut‐off of 14/60. PPP score was significantly greater before administration of the analgesic than after (paired‐sample t‐tests, p < 0.001). Though there was no significant difference in mean pre‐ and postoperative scores, highest PPP score occurred in the first 24 hours after surgery in 14 (47%) children. Results suggest that the PPP is reliable and valid and has potential for use both clinically and in intervention research.

Not knowing—the problem of pain in children with severe neurological impairment

This study uses a grounded theory approach to explore the diagnostic and clinical decision-making processes used by parents and healthcare professionals in relation to pain in children with severe to profound neurological impairment. Three forms of knowledge are required for optimal pain assessment and management (1) knowing the child, (2) familiarity with children with the same or similar conditions and (3) knowing the science. Pain relief can be compromised by systems of care that fragment rather than integrate care. A model which integrates knowledge of child, population and science is proposed together with an intersubjective attitude to assessing pain.

Experiences of posttraumatic growth in siblings of children with cancer.

As survival rates continue to improve for children diagnosed with cancer, strides in achieving better psychosocial outcomes for both children with cancer and their families have been accentuated. The current study aimed to explore the experiences of siblings of children diagnosed with cancer and attempted to overcome some of the limitations described in previous research. Primarily, the study considered the theoretical framework of posttraumatic growth (PTG) in the project design and analysis. Semi-structured interviews were completed with six siblings. Thematic analysis was employed to identify themes within the data set as a whole. The data revealed that siblings experienced a range of difficult emotions throughout the cancer trajectory as well as experiencing remarkable changes in their lives. This included both positive and negative changes. These changes included increased empathy and resilience, improved family relationships, disrupted routine, increased responsibility and perceived changes in the ill child. Siblings described factors which they found helpful and unhelpful in adjusting to these changes. The report ends with a discussion of the themes and their clinical and theoretical implications. The report also highlights the research limitations and areas for future investigation.

Verbal Information Transfer in Real-Life: When Mothers Worry About Their Child Starting School

Verbal information transfer, one of Rachman’s three pathways to fear, may be one way in which vulnerability for anxiety may be transmitted from parents to children. A community sample of mothers and their preschool-aged children (N = 65) completed observational tasks relating to the child starting school. Mothers were asked to tell their child about social aspects of school; then children completed a brief play assessment involving ambiguous, school-based social scenarios. Mothers completed self-report questionnaires on social anxiety symptoms, general anxiety and depressive symptoms as well as a questionnaire on child anxiety symptoms and indicated whether they were personally worried about their child starting school. There was a significant difference in the information given to children about school between mothers who stated they were worried and those who stated they were not, with mothers who were worried more likely to mention unresolved threat, use at least one anxiety-related word, and show clear/consistent negativity (all ps < .01). Significant associations were also found between the emotional tone of mothers’ descriptions of school and children’s own representations of school. These findings support the theory that the information mothers give to their child may be influenced by their own concerns regarding their child, and that this verbal information affects child representations.

Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample

Abstract Purpose: This study investigated levels of posttraumatic stress symptoms (PTSS) in children with cancer and their siblings from a British sample. It also examined aspects of the Ehlers and Clark1 model of posttraumatic stress disorder in the current population. Methods: Sixty participants (34 children with cancer and 26 siblings) aged between 8 and 18 years completed measures of PTSS, maladaptive appraisals, trauma-centered identity, perceived social support and family functioning. Results: Over a quarter of the sample scored above the clinical cutoff on the Impact of Events Scale-Revised. No differences were observed between patients and siblings with respect to levels of PTSS. Maladaptive appraisals and age were found to account for unique variance in levels of PTSS for the overall sample. Conclusions: Rates of PTSS in the sample were relatively high. Support was found for aspects of the Ehlers and Clark1 model in explaining PTSS for the current population.