Kristen E. Jastrowski Mano

Parent/Nurse-controlled Analgesia for Children With Developmental Delay

BackgroundChildren with developmental delay are often unable to verbalize pain or advocate for themselves owing to cognitive, motor, or verbal limitations, which puts them at increased risk for poor pain assessment and management. Although patient-controlled analgesia has been shown to be safe, effective, and superior to intermittent opioid dosing, not all children can operate patient-controlled analgesia independently. Parent/nurse-controlled analgesia (PNCA) may be an option for these children. However, the safety and efficacy of PNCA have not been thoroughly evaluated and many practitioners are reluctant to use it. ObjectivesThe purpose of this study was to evaluate the outcomes associated with PNCA in pediatric patients with identified developmental delay. MethodsA retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 71 children with developmental delay. Data were collected for 72 hours or until the PNCA was discontinued, whichever came first. ResultsMean pain scores were low, as was the amount of opioid required to keep patients comfortable. Side effects, with the exception of oxygen therapy, were similar to previous studies regarding PNCA. Somnolence and respiratory depression leading to the administration of naloxone occurred in 2.8% of patients, and potential causes were identified. DiscussionPain scores, side effects, and adverse events suggest that PNCA may be an effective method of pain control for children with developmental delay. Diligent monitoring and education are crucial to ensure safety.

Distinct Influences of Anxiety and Pain Catastrophizing on Functional Outcomes in Children and Adolescents With Chronic Pain

OBJECTIVES Examine whether anxiety and pain catastrophizing are distinct constructs in relation to functional outcomes in pediatric chronic pain, and whether they differentially predict functional outcomes based on age. METHODS In all, 725 youth (191 children, 534 adolescents) with chronic pain completed measures of pain characteristics, anxiety, pain catastrophizing, functional disability, and health-related quality of life (HRQOL). Structural equation modeling was used to examine interrelationships. RESULTS Anxiety and pain catastrophizing were distinct. For both children and adolescents, pain catastrophizing predicted pain, functional disability, and HRQOL, and was a stronger predictor of pain intensity. For children, anxiety predicted HRQOL, and pain catastrophizing was a stronger predictor of functional disability. For adolescents, anxiety predicted functional disability and HRQOL, and anxiety was a stronger predictor of HRQOL. CONCLUSIONS There were age-related differences regarding whether anxiety or pain catastrophizing more strongly predicted specific functional outcomes. Assessment and intervention efforts should emphasize both anxiety and pain catastrophizing.

Pressure Pain Threshold and Anxiety in Adolescent Females with and without Juvenile Fibromyalgia: A Pilot Study.

Objectives: Reduced pain thresholds have been documented in adult fibromyalgia, but there are no quantitative studies of altered pain sensitivity in adolescents with juvenile fibromyalgia (JFM). The current study examined differences in pressure pain sensitivity between adolescent females with JFM and healthy controls. The relationship between levels of anxiety and pain were also examined. Methods: A total of 34 JFM (15.4±1.4 y old) and 31 controls (14.5±1.3 y old) completed self-report measures of pain and anxiety. Pressure pain threshold was assessed (palm and forehead sites) with a hand-held algometer. Participants indicated the first sensation of pain and then rated the intensity of pain on a Numerical Rating Scale. Results: Adolescents with JFM exhibited greater sensitivity to pressure pain compared with controls. While the difference between JFM and controls was only observed at the forehead, the intensity of pain produced by the pressure algometry at both sites was significantly higher in the JFM participants compared with controls. Correlations between clinical pain and anxiety were significant for the JFM group only. No relationships were observed between anxiety and pressure pain for either group. Discussion: This study is a first step toward investigating mechanisms of altered pain processing in adolescents with JFM. Adolescents with JFM were found be more sensitive to pressure pain than their healthy peers, which suggests a propensity for sensitization of peripheral and/or central nociceptive information often reported in adult fibromyalgia, and which does not appear to be affected by anxiety.

Fluid reasoning and reading difficulties among children with ADHD

Abstract Background: Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience difficulties in reading and in fluid reasoning (Gf). According to Cattell’s Investment Theory (1987), Gf is a causal factor in the development of crystallized knowledge (Gc) and academic skills; therefore, the co-occurrence of reading and Gf difficulties within ADHD may not be coincidental. Methods: In the present study with children with both ADHD and reading difficulties (n = 187; 61% male; Mage = 9.2), we utilized mediation analyses to test direct and indirect (through Gc, phonemic awareness, and rapid automatized naming [RAN]) effects of Gf on four basic reading skills: untimed word recognition, untimed phonemic decoding, word reading efficiency, and phonemic decoding efficiency. Results: The direct effect of Gf on all reading skills was nonsignificant; however, significant indirect effects were observed. Specifically, Gf exerted an effect indirectly onto all reading skills through a serial and joint mechanism comprised of Gc and phonemic awareness (i.e., Gf → Gc → phonemic awareness → reading achievement). Gf also exerted an effect indirectly onto untimed word recognition and phonemic decoding through phonemic awareness (i.e., Gf → phonemic awareness → untimed word recognition/untimed phonemic decoding). Conclusion: Results build upon Cattell’s Investment Theory by linking Gf with reading difficulties among children with ADHD, suggesting that such difficulties may arise from weaknesses in Gf and insufficient investment of Gf into reading through Gc and phonemic awareness.

GENDER MODERATES ASSOCIATION BETWEEN EMOTIONAL-BEHAVIORAL PROBLEMS AND TEXT COMPREHENSION IN CHILDREN WITH BOTH READING DIFFICULTIES AND ADHD

Evidence suggests that higher order linguistic functioning such as text comprehension is particularly vulnerable to emotional modulation. Gender has been identified as an important moderating variable in emotional expression such that girls tend toward internalizing emotions (e.g., sadness, anxiety) whereas boys tend toward externalizing emotions (e.g., anger, combativeness), which may influence the relationship between emotion and text comprehension. The present study examined whether gender moderates the relationship between emotional-behavioral problems and text comprehension among children (n = 187; boys= 115, girls = 72) with both word reading difficulties (RD) and attention-deficit/hyperactivity disorder (ADHD), a sample widely acknowledged to be at increased risk for developing emotional-behavioral problems such as anxiety, poor academic self-concept, and delinquency. A moderated regression analysis tested for the significance of two separate interaction terms (i.e., gender × externalizing problems, gender × internalizing problems) after controlling for gender, IQ, basic reading skills, cognitive-linguistic processes closely related to reading, attentional problems, internalizing problems, and externalizing problems. Results indicated that gender significantly and uniquely moderates the relationship between emotional-behavioral problems and text comprehension. Specifically, text comprehension was relatively lower among girls with relatively higher externalizing problems, whereas no such association was observed among boys. These results contribute to our understanding of cognition-emotion interactions within reading development and raise important implications.

The Effect of Parent Anxiety on Treatment Acceptability and Retention of Diagnostic Feedback

This study examined the effect of parent anxiety on treatment acceptability and retention of diagnostic feedback. Mothers (N = 187) of children ages 2 to 14 years recruited primarily through online parenting groups were randomly assigned to one of four vignettes that varied on ambiguity of diagnostic label (low vs. high) and ambiguity of diagnostic feedback (low vs. high). Participants completed measures of state and trait anxiety, retention of feedback, and treatment acceptability. Mothers reporting high trait anxiety endorsed greater treatment acceptability (F = 11.57, p = .001, η p 2 = .09). Those reporting high state anxiety retained more information, t(84.96) = −5.35, p < .001, Cohen’s d = .99. A significant interaction emerged between trait anxiety and diagnostic label on parent satisfaction (F = 4.95, p = .028, η p 2 = .04). Results suggest that parent anxiety may affect retention and likelihood of pursuing treatment. Future research is needed to investigate whether differences in parent anxiety translate into meaningful differences in their pursuit of treatment.

“What Does Weight Have to Do with It?” Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child’s initial appointment; questions addressed parents’ perceptions of their child’s weight, and their perceptions of multiple aspects of the relationship between their child’s weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child’s weight; this group of parents was also more concerned (p < 0.05) about their child’s weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child’s weight contributed to his/her pain, or that weight was relevant to their child’s pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child’s pain. Results support the need for addressing parents’ perceptions of their child’s weight status, and educating parents about the relationship between excessive weight and chronic pain.