Larry L. Mullins

Survivors of childhood brain tumors: Behavioral, emotional, and social adjustment

This paper reviews the literature on the psychological adjustment and quality of life in children who survive brain tumors. A total of 31 studies were reviewed. Findings are discussed in terms of the rates of general psychological adjustment, internalizing behavior problems, externalizing behavior problems, social competence, correlates or predictors of adjustment, and quality of life among survivors. Although these survivors appear to be at risk for compromised social competence and long-term quality of life, reports in the literature on rates of psychological adjustment in this population vary widely. Limitations in the current literature are discussed including inadequate assessment techniques, lack of appropriate comparison groups, and small sample sizes. Directions for future research are offered.

The relationship of parental overprotection, perceived vulnerability, and parenting stress to behavioral, emotional, and social adjustment in children with cancer

To examine the relationship of self‐reported parental overprotection, perceived child vulnerability, and parenting stress to parent‐reported behavioral, emotional, and social adjustment of children currently on treatment for cancer.

The Relationship of Parental Overprotection and Perceived Child Vulnerability to Depressive Symptomotology in Children With Type 1 Diabetes Mellitus: The Moderating Influence of Parenting Stress

Our study examined the relationship between parental overprotection and perceived child vulnerability to self-reported depressive symptoms in 8- to 12-year-old children diagnosed with type 1 Diabetes Mellitus. The moderating influence of parenting stress was also examined. Mothers (N = 43) completed measures of parental overprotection, perceived child vulnerability, and parenting stress, and the children completed a measure of child depression. Findings revealed that both child vulnerability and parenting stress were associated with higher levels of depressive symptoms; no relationship was found between overprotection and child depressive symptoms. Regression results further indicated that parenting stress moderated the relationship between perceived child vulnerability and depressive symptomotology. Thus, parenting stress appears to magnify the relationship between perceived child vulnerability and child-reported depressive symptoms. Our findings lend additional empirical support for the transactional relationship between discrete parenting variables and child distress. These results also support the view that overprotection and child vulnerability are distinct but overlapping constructs. Interventions that target specific parenting approaches and general parenting stress may be effective in ameliorating child distress.

Posttraumatic Stress and General Distress Among Parents of Children Surviving a Brain Tumor

In this preliminary study we examined both posttraumatic stress and general distress among parents of children diagnosed with a brain tumor. Participants included 28 parents of children diagnosed with a brain tumor who completed self-report measures of posttraumatic stress, general distress, coping, and illness uncertainty. Findings revealed that participants reported high levels of posttraumatic stress and general distress. Greater levels of emotion-focused coping and perceived uncertainty were associated with a higher frequency of both posttraumatic stress symptoms and general distress. However, perceived uncertainty was the strongest predictor of both indexes of distress. Emotion-focused coping predicted general distress, but not posttraumatic stress symptom severity. Overall, parents of children surviving a brain tumor appear to be at risk for both posttraumatic stress and general distress. Uncertainty in illness may constitute a primary risk factor for adjustment problems. CHILDREN’S HEALTH CARE, 30(3), 169–182 Copyright

Disease-specific measure of quality of life for myasthenia gravis.

In 2000 a Task Force of the Myasthenia Gravis Foundation of America recommended development of a quality of life (QOL) measure specific for myasthenia gravis (MG). Extant investigations have relied solely on assessment of physical aspects of daily living in conceptualizing QOL, despite research that emphasizes the importance of including psychological factors. In the present study we developed a QOL questionnaire specific to MG (MG‐QOL) that assesses both physical and psychological aspects of function. The MG‐QOL questionnaire was administered as a secondary measure of efficacy in a recently completed prospective trial of mycophenolate mofetil involving 80 MG patients. Comparisons indicated that the MG‐QOL performed better than a nondisease‐specific measure of QOL, the SF‐36, in demonstrating disease change as assessed by the primary measure, the Quantitative MG score (QMG). The MG‐QOL correlated highly with the SF‐36, and demonstrated stronger associations with independent physical ability ratings. Results from this study support the use of this new measure of QOL, both clinically and in treatment trials of MG. Muscle Nerve 38: 947–956, 2008

Measures of general pediatric quality of life: Child Health Questionnaire (CHQ), DISABKIDS Chronic Generic Measure (DCGM), KINDL‐R, Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales, and Quality of My Life Questionnaire (QoML)

Purpose. To measure health-related quality of life (HRQOL) in children and adolescents ages 5–18 years. This measure consists of child report (ages 10–18 years) and 2 versions of parent-proxy report (ages 5–18 years) of the child’s HRQOL. It can be used with healthy children and those with both acute and chronic health conditions. Content. Assesses for 14 physical and psychosocial domains: general health perceptions, physical functioning, role/social physical functioning, bodily pain, role/social emotional functioning, role/social behavioral functioning, parent impact-time, parent impact-emotional, self-esteem, mental health, behavior, family activities, family cohesion, and change in health. Number of items. The child-report questionnaire (CHQCF87) consists of 87 items. The long parent-report questionnaire (CHQ-PF50) consists of 50 items, and the short parent-report questionnaire (CHQ-PF28) consists of 28 items. Response options/scale. The response options for the CHQ are ordinal scales that vary by the item. Each item consists of 4–6 response options. Additionally, each scale consists of varying numbers of items. Recall period for items. Varies by subscale. Most scales have a recall period of 4 weeks. The change in health subscale has a recall period of 1 year, and the global health, general health perception, and family cohesion subscales ask about the child’s health “in general.” Endorsements. No information. Examples of use. Apaz MT, Saad-Magalhaes C, Pistorio A, Ravelli A, de Oliveira Sato J, Marcantoni MB, et al, for the Paediatric Rheumatology International Trials Organisation. Health-related quality of life of patients with juvenile dermatomyositis: results from the Paediatric Rheumatology International Trials Organisation multinational quality of life cohort study. Arthritis Rheum 2009; 61:509–17. Brunner HI, Higgins GC, Wiers K, Lapidus SK, Olson JC, Onel K, et al. Health-related quality of life and its relationship to patient disease course in childhoodonset systemic lupus erythematosus. J Rheumatol 2009;36: 1536–45 (1). Gutierrez-Suarez R, Pistorio A, Cespedes Cruz A, Norambuena X, Flato B, Rumba I, et al. Health-related quality of life of patients with juvenile idiopathic arthritis coming from 3 different geographic areas: the PRINTO multinational quality of life cohort study. Rheumatology (Oxford) 2007;46:314–20 (2). Oliveira S, Ravelli A, Pistorio A, Castell E, Malattia C, Prieur AM, et al, for the Pediatric Rheumatology International Trials Organization (PRINTO). Proxy-reported healthrelated quality of life of patients with juvenile idiopathic arthritis: the Pediatric Rheumatology International Trials Organization multinational quality of life cohort study. Arthritis Rheum 2007;57:35–43 (3). Ruperto N, Buratti S, Duarte-Salazar C, Pistorio A, Reiff A, Bernstein B, et al. Health-related quality of life in juvenile-onset systemic lupus erythematosus and its relationship to disease activity and damage. Arthritis Rheum 2004; 51:458–64. Selvaag AM, Flato B, Lien G, Sorskaar D, Vinje O, Forre O. Measuring health status in early juvenile idiopathic arthritis: determinants and responsiveness of the Child Health Questionnaire. J Rheumatol 2003;30:1602–10 (4). Takken T, Elst E, Spermon N, Helders PJ, Prakken AB, van der Net J. The physiological and physical determinants of functional ability measures in children with juvenile dermatomyositis. J Rheumatol 2002;42:591–5. Stephanie E. Hullmann, MS, Jamie L. Ryan, MS, Rachelle R. Ramsey, MS, John M. Chaney, PhD, and Larry L. Mullins, PhD: Oklahoma State University, Stillwater. Address correspondence to Stephanie E. Hullmann, MS, Oklahoma State University, 116 North Murray Hall, Stillwater, OK 74078. E-mail: stephanie.hullmann@okstate.edu. Submitted for publication January 23, 2011; accepted in revised form May 10, 2011. Arthritis Care & Research Vol. 63, No. S11, November 2011, pp S420–S430 DOI 10.1002/acr.20637

An Intervention to Decrease Uncertainty and Distress Among Parents of Children Newly Diagnosed With Diabetes: A Pilot Study

This pilot study reports findings from a randomized clinical trial of a novel intervention for parents of children newly diagnosed with Type 1 diabetes. The intervention was designed to decrease parental uncertainty and distress as well as child behavioral problems by teaching parents skills to manage uncertainty. Thirty-four families were randomly assigned to either an intervention (IG) or a treatment as usual (TAU) group. Parents completed measures of distress, uncertainty, and child behavior problems at baseline, 1 month, and 6 months postintervention. In the IG, significant reductions were observed for maternal and paternal distress as well as maternal ratings of child behavior problems. No changes were observed for the TAU, except for father-reported reductions in child internalizing symptoms at 1 month postintervention. Preliminary data suggest that, with further development and testing, the intervention has potential to be an effective tool to reduce paternal distress and possibly child behavior problems.

Anxiety and Depression in Older Adolescents With Long-Standing Asthma: The Role of Illness Uncertainty

This study examined the differential contribution of illness uncertainty to self-reported anxiety and depression in a sample of older adolescents with childhood-onset asthma. Fifty-six individuals completed measures of illness uncertainty, anxiety, and depression. In addition, objective assessments of illness severity were obtained via a semistructured interview and pulmonary function test. Results revealed that illness uncertainty contributed significant variance to anxiety after statistically controlling the effects of demographic and disease parameters and depressive symptomatology; illness uncertainty did not contribute significant variance to depression. Findings suggest that interventions should target illness uncertainty and psychosocial education, as well as early identification and treatment of anxiety in this understudied population.

Results of a clinical trial of the holmium:YAG laser in disc decompression utilizing a side-firing fiber : A two-year follow-up

Laser‐assisted disc decompression (LADD) is an operative technique for the treatment of symptomatic, nonsequestered herniated nucleus pulposus that has failed to respond to conservative treatment. The current study reports 2‐year follow‐up data.

The Influence of Respite Care on Psychological Distress in Parents of Children With Developmental Disabilities: A Longitudinal Study

In this study, we longitudinally examined the influence of a brief (3-7 day) respite care admission on psychological distress and parenting stress in parents of children admitted to a center for developmental disabilities. A comparison group of parents of children who were admitted for short-term (30-day) inpatient treatment was utilized. Parents (N = 80) completed the Brief Symptom Inventory (Derogatis, 1993a) and the Parenting Stress Index (Abidin, 1990) at time of admission, discharge, and at 6-month follow-up. Therapists completed measures of functional ability at admission and discharge. Analyses indicate that psychological distress was significantly lower at discharge and 6-month follow-up for both groups. Parenting stress was significantly lower at discharge, but at 6-month follow-up had returned to admission levels. Notably, both groups demonstrated improved functional ability from admission to discharge despite the respite care group receiving little formal therapy over a much shorter stay in the...