Kristoffer S. Berlin

A Micro-Process Analysis of Functional Analytic Psychotherapy's Mechanism of Change

This study sought to clarify the micro-process of Functional Analytic Psychotherapy (FAP) by using the Functional Analytic Psychotherapy Rating Scale (FAPRS) to code every client and therapist turn of speech over the course of successful treatment of an individual meeting diagnostic criteria for depression and histrionic personality disorder. Treatment consisted of cognitive behavioral therapy alone followed by the addition of FAP techniques in a unique A / A+B design. In-session client behavior improved following the shift to FAP techniques, and micro-process data suggested that client behavior was effectively shaped by in-vivo FAP procedures. These results support FAPs purported mechanisms of change and highlight the advantages of utilizing molecular coding systems to explore these mechanisms.

Patterns of Medical and Developmental Comorbidities Among Children Presenting With Feeding Problems: A Latent Class Analysis

Objective: Children with feeding problems often have multiple co-occurring medical and developmental conditions; however, it is unknown whether patterns of comorbidity exist and whether they relate to important feeding-related health outcomes. The main objective of this study was to examine (1) the relationship between the number of medical and developmental comorbidities and important feeding-related health outcomes; (2) how various comorbidities interact and form empirically derived patterns; and (3) how empirically derived patterns of comorbidity relate to weight status, nutritional variety, and child and parent mealtime behavior problems. Methods: The medical records of 286 children (mean age = 35.56 months) seen at an outpatient feeding disorders clinic were reviewed. Child weight status, nutritional variety, and child and parent mealtime behavior problems were assessed using standardized measures. The lifetime occurrence of medical and developmental conditions was reliably coded. Empirically derived patterns of comorbidity were generated via latent class analyses. Results: Latent class analyses generated 3 comorbidity patterns: “Behavioral” (58% of cases), “Developmentally Delayed” (37%), and “Autism Spectrum Disorder” (ASD, 5%). The Autism Spectrum Disorder group was found to have less nutritional variety compared to the Behavioral and Developmentally Delayed groups. No differences were found between groups in terms of percent ideal body weight, or severity of child or parent mealtime behavior problems. Conclusion: Multiple co-occurring conditions of children with feeding problems were empirically reduced to 3 patterns of comorbidities. Comorbidity patterns were largely unrelated to weight status and child or parent mealtime behavior problems. This suggests that medical and developmental conditions confer general, rather than specific, risk for feeding problems in children.

Time-Window Sequential Analysis: An Introduction for Pediatric Psychologists

OBJECTIVE Pediatric psychologists are often interested in interactions among individuals (e.g., doctors and patients, parents and children). Most research examining the nature of these interactions has used correlational analyses. Sequential analysis provides greater detail on contingencies during interactions and the way that interactions play out over time. The purpose of this article is to offer a non-technical introduction to sequential analyses for pediatric psychologists. METHODS A more recent derivation of the basic method, called time-window sequential analysis, is introduced and distinguished from other forms of sequential analysis. RESULTS A step-by-step pediatric psychology example of time-window sequential analysis is provided and the integration of sequential analysis with traditional statistical methods is discussed. An example of physician-child interaction during anesthesia induction is used to illustrate the technique. CONCLUSION Sequential analysis is a technique that is useful to pediatric psychologists who are interested in contingencies among data collected over time.

A Biopsychosocial Model of Normative and Problematic Pediatric Feeding

A comprehensive model is presented that (a) highlights factors that have been implicated in the development and maintenance of feeding problems in both normal and clinical populations; and (b) provides a framework for the prevention, management, and treatment of feeding problems across the range of physically healthy children to children with acute and chronic illnesses. Relevant literatures and feeding models were synthesized to present a comprehensive unified biopsychosocial model that may aid in the prediction and synthesis of information about feeding and eating in both normal and clinical populations and provide a framework for interdisciplinary research and intervention.

Assessing Family-based Feeding Strategies, Strengths, and Mealtime Structure with the Feeding Strategies Questionnaire

OBJECTIVE Develop a questionnaire to assess family-based feeding strategies, strengths, and mealtime structure for use with children with feeding problems; validate this new instrument with caregivers of young children from the community and a specialty feeding-clinic; and examine preliminary evidence for reliability and validity. METHODS Community caregivers (n = 702) and caregivers seeking services at a pediatric feeding specialty clinic (n = 288) completed the Feeding Strategies Questionnaire (FSQ). A smaller portion of these families also completed an established feeding measure. RESULTS Exploratory and confirmatory factor analyses were conducted to develop and validate the FSQ factor structure that resulted in six scales: Mealtime Structure, Consistent Mealtime Schedule, Child Control of Intake, Parent Control of Intake, Between Meal Grazing and Encourages Clean Plate. Evidence of reliability and validity was obtained. CONCLUSION It appears the FSQ can aid the assessment of feeding strategies relevant to the prevention or treatment of pediatric feeding difficulties.

Nutritional and Psychosocial Outcomes of Gastrostomy Tube-Dependent Children Completing an Intensive Inpatient Behavioral Treatment Program

Objectives: Limited published data describe the long-term effects of behavioral strategies to wean children from gastrostomy tube (GT) feeding dependence. This study presents data relating to nutritional and psychosocial outcomes observed during a 1-year period in medically complex GT feeding–dependent patients who completed an inpatient behavioral-based tube weaning protocol. Methods: This was a retrospective study of prospectively and retrospectively collected data associated with a clinical cohort of 77 children diagnosed as having a feeding disorder, GT feeding dependence (>1 year), and an inability to maintain acceptable growth via oral feeding completing an inpatient tube weaning protocol. Nutritional data (percentage of ideal body weight, and oral energy intake as percent ofenergy goal) and psychosocial data (mealtime behavior problems, quality of caregiver and child interactions, and parenting stress) were assessed pre- and post-hospitalization. Nutritional data were also monitored longitudinally at 1, 3, 6, and 12 months postreatment. Data were grouped for retrospective analysis. Results: Mealtime environment and feeding behaviors significantly improved, and all of the patients demonstrated reductions in tube dependence aside from 1 treatment failure. Fifty-one percent of patients were fully weaned from tube feeding after 2 weeks and an additional 12% completed weaning in the outpatient follow-up clinic within 1 year. Patients maintained nutritional stability at the 1-year posttreatment follow-up appointment. Conclusions: Inpatient behavioral interventions are highly effective and safe for transitioning long-term tube feeding children to oral feeding.

Assessing Children's Mealtime Problems With the Mealtime Behavior Questionnaire

A caregiver questionnaire that assesses mealtime problems in children aged 2 to 6 years old was developed. Community caregivers (n = 712) completed the Mealtime Behavior Questionnaire (MBQ) and measures of child behavior and family mealtime behaviors and environment. Exploratory and confirmatory factor analyses revealed and validated the MBQs 4 subscales (food refusal/avoidance; food manipulation; mealtime aggression/distress; and choking/, gagging/vomiting). Mealtime problems occurred from “sometimes” to “always” for 1% to 61% of the sample. The MBQ demonstrated excellent to fair internal consistencies, and preliminary evidence for validity was found.

Contextual assessment of problematic situations identified by insulin pump using adolescents and their parents

For youth with type 1 diabetes mellitus (T1DM) using insulin pumps, maintaining metabolic control through appropriate selfcare is a complex biopsychosocial process reciprocally influenced by individual, familial, social, and technological variables. Adolescents (n 20) with T1DM using insulin pumps and their parents (n 34) were interviewed to determine (a) the most frequent and difficult situations faced by adolescents and their parents, (b) how the frequency and difficulty of these situations vary as a function of the respondent, the nature (content) of the problem, and the systemic context(s) in which problems occur, and (c) the relationship between the average difficulty rating and the youth’s metabolic control. The most frequently reported problematic situations were T1DM self-care. For youth these problems were predominantly related to social and peer contexts; parents identified problems primarily related to the family context. Implications and additional analyses are reported.

Integrating Mediation and Moderation to Advance Theory Development and Testing

OBJECTIVE The concepts and associated analyses of mediation and moderation are important to the field of psychology. Although pediatric psychologists frequently incorporate mediation and moderation in their theories and empirical research, on few occasions have we integrated mediation and moderation. In this article, conceptual reasons for integrating mediation and moderation are offered. METHOD We illustrate a model that integrates mediation and moderation. RESULTS In our illustration, the strength of an indirect or a mediating effect varied as a function of a moderating variable. CONCLUSIONS Clinical implications of the integration of mediation and moderation are discussed, as is the potential of integrated models to advance research programs in pediatric psychology.

Attributions of Teacher Reactions to Diabetes Self-care Behaviors

OBJECTIVE This study had two objectives: examine relationships among negative attributions of teacher reactions, anticipated adherence difficulties, teacher support, diabetes stress, and metabolic control; and develop questionnaires to test these relationships. METHODS One hundred and two youths with type 1 insulin-dependent diabetes completed instruments measuring attribution of teacher reactions, anticipated adherence, teacher support, and diabetes stress. Metabolic control was measured by percentage of hemoglobin A(1c). RESULTS Structural equation modeling demonstrated that negative attributions had direct effects on anticipated adherence difficulties and diabetes stress. Diabetes stress had a direct effect on metabolic control. Negative attributions had a significant indirect effect on metabolic control through associations with diabetes stress. Teacher support moderated the path between negative attributions and anticipated adherence difficulties. CONCLUSIONS Youths making negative attributions about teachers reactions are likely to find adherence difficult in school situations and have increased stress. Results are discussed in terms of a social information processing model of adjustment and practical applications.