Leslie A. Gavin

Age differences in adolescents' perceptions of their peer groups.

This study employed social psychological theories of group formation to conceptualize and predict age differences in peer groups. Adolescents were administered questionnaires about the characteristics of their peer groups. Early and middle adolescents reported placing more value on being in a popular group and perceived more group conformity and leadership within their groups than preand late adolescents. Early and middle adolescents also reported more antagonist interactions and fewer positive interactions with group members and more antagonistic interactions with those not part of their peer groups. Girls reported having more positive group interactions, being more bothered by negative interactions, and having more permeable group boundaries. Boys reported more negative interactions with those outside their groups. Results are discussed in the context of adolescent development. Adolescence is a period in which individuals are expanding their perspective beyond the family and learning how to negotiate relationships with others in the social system. Peers, particularly group members, become important social referents (Sherif & Sherif, 1964; Youniss & Smollar, 1985). The peer group can also serve as a bridge from childhood parental dependencies to a sense of autonomy and connectedness with the greater social

Psychological and family characteristics of adolescents with vocal cord dysfunction

Vocal cord dysfunction (VCD) is a respiratory disorder often confused with asthma. Although previous case reports have implicated family and/or individual psychopathology in the etiology of this condition, this is the first paper to present prospective, case-control empirical data on a group of pediatric patients with VCD. A case-control methodology was employed to examine patients in terms of both family and individual functioning. Results indicate that patients with VCD were not different from asthmatic controls on measures of family functioning. However, they did experience significantly higher levels of anxiety and received a higher number of anxiety-related diagnoses such as separation anxiety and generalized anxiety disorder on a structured psychiatric interview. The nature of the relation between VCD and psychological symptoms in children is discussed. Etiologic and treatment issues are examined in the context of the findings.

Parental criticism and treatment outcome in adolescents hospitalized for severe, chronic asthma

This pilot study investigated the relationship between parental criticism and medical treatment outcome across an inpatient hospitalization in 19 adolescents with severe, chronic asthma. Parental criticism toward their asthmatic adolescent was assessed using the Five Minute Speech Sample technique (FMSS) at the beginning of the adolescents inpatient stay at a national asthma referral center. Those adolescents whose parents were rated as high in criticism on the FMSS were found to have greater improvement in their overall asthma severity, greater reduction in their steroid medication dose, and shorter lengths of stay in the hospital than those whose parents were rated as low in criticism. The adolescents whose parents were rated as high in criticism also showed lower compliance with their prescribed theophylline and oral steroid medication at admission than the low criticism group. These findings do not appear to be due to misdiagnosis secondary to the presence of vocal cord dysfunction or to the allergy status of the children. Clinical implications and possible causal mechanisms underlying these findings are discussed.

The Five Minute Speech Sample in Children with Asthma: Deconstructing the Construct of Expressed Emotion

OBJECTIVE To use the Five Minute Speech Sample (FMSS) to assess Expressed Emotion (EE) in various samples of children with asthma in order to clarify (1) developmental and validity issues for the EE construct and (2) the use of the FMSS technique, specifically, in children with chronic medical illness. METHOD Data were collected on a sample of 84 adolescents with severe, chronic asthma who had failed outpatient management. In addition, a sample of 30 children with asthma, ages 6-9. were recruited from an outpatient pediatric clinic. A comparison sample of 15 children without any chronic illness, ages 6 9, were recruited by notices posted in the community. The primary caregiver of each child was assessed using the FMSS. RESULTS FMSS interviews were reliability coded in all samples. Rates of high Criticism (FMSS CRIT), Emotional Overinvolvement (FMSS EOI), and EE were comparable to rates previously reported in child and adolescent samples. Although the validity for ratings of FMSS CRIT was well supported, the validity of FMSS EOI ratings and the overall EE construct were more problematic. CONCLUSIONS The FMSS is a useful and largely valid measure in children with asthma. Ratings of FMSS CRIT were found to have strong validity. There was little problem shifting the context of FMSS administration from chronic mental to chronic medical illness, but a variety of developmental considerations arose, especially regarding FMSS EOI ratings. Although we raise concerns about viewing EE as a valid construct, it may remain a useful predictive index.

The Asthma Responsibility Questionnaire: Patterns of Family Responsibility for Asthma Management

This study provided preliminary validation of the Asthma Responsibility Questionnaire (ARQ), a brief measure that assesses the division of family responsibility for 10 asthma management tasks. Data were collected from 2 samples of children (ages 7 to 15 years) and their mothers, recruited from an asthma camp (Sample 1) and various community sources (Sample 2). The ARQ demonstrated good internal consistency and convergent validity. Child and mother reports of child responsibility were modestly correlated and increased with child age by mother and child report. Four-year longitudinal data demonstrated significant increases in child responsibility for asthma management. Overall, children reported a higher degree of responsibility for themselves than mothers did for them. CHILDREN’S HEALTH CARE, 30(3), 183–199 Copyright

Reliability of the model MC-311 MDI Chronolog

BACKGROUND The Model MC-311 MDI Chronolog (Medtrac Technologies, Lakewood, Colo) is an electronic device for monitoring adherence to metered-dose inhalers (MDIs). It is a thermistor-actuated, microprocessor-equipped device that dispenses inhaled medication while recording the date and time of each canister activation. OBJECTIVE We evaluated the reliability of the MC-311 MDI Chronolog to determine whether the model could accurately record and report the date, time, and number of MDI actuations. METHODS Twenty-four of the MC-311 Chronologs were discharged at 8 hourly intervals across 8 days. Battery voltage was assessed before and after the experiment. The mouthpieces of 12 Chronologs were washed daily. RESULTS By using generous criteria for acceptable reliability, only 10 of 24 (42%) were rated as acceptable. None of these 10 Chronologs recorded 320 or greater actuations (mean +/- SD, 293.9 +/- 13.3; range, 266 to 308); all reliable Chronologs underestimated MDI activation. An additional 6 devices had an initial signature of erroneous recordings dating from device initialization. After removing this signature, the remaining data showed acceptable reliability. All the remaining Chronologs judged to be unacceptable showed time series patterns of seizures (ie, bursts of clustered, erroneous records). Seizures were distributed across trial days, were associated with washing, and preceded all 4 cases of battery failure. Damage to the thermistor is the likely cause of seizure-pattern failures. CONCLUSIONS In summary, because of a combination of a clear underreporting bias with frequent initialization and seizure-pattern failures, the Model MC-311 MDI Chronolog is not recommended for use in clinical care or research

Clinical outcomes of steroid-insensitive asthma

BACKGROUND Steroid insensitivity increasingly is being recognized in patients with severe, chronic asthma. Virtually no data exist regarding the clinical outcomes of steroid insensitive (SI) asthma despite clear expectations of poorer longitudinal course for this condition. METHODS We obtained 2-year follow-up data from 34 pediatric patients who had been evaluated for steroid insensitivity at a national asthma referral center. Outcomes evaluated included current oral glucocorticoid (GC) dose; number of GC bursts, emergency room visits, and hospitalizations for asthma in the prior 12 months; Asthma Functional Severity; Pediatric Asthma Quality of Life; and Pediatric Asthma Caregivers Quality of Life. RESULTS At follow-up, patients with SI asthma and their caregiving parent both reported poorer quality of life (QOL) compared with those with steroid sensitive (SS) asthma (adolescent: 4.6 +/- 0.4 versus 5.6 +/- 0.3; P < .05; caregiver: 5.1 +/- 0.4 versus 6.2 +/- 0.2; P < .05). Steroid-insensitive patients showed no significant difference in GC dose, number of GC bursts, emergency room visits or hospitalizations, or Asthma Functional Severity compared with SS patients. CONCLUSIONS Steroid insensitivity was associated with significantly poorer QOL at 2-year follow-up. Steroid insensitive patients did not show poorer clinical outcomes compared with SS patients as assessed by current steroid requirements and health care utilization. Overall, the observed pattern of results suggests that SI asthma may be a worse form of asthma because a more fixed pattern of lung obstruction has developed. Further longitudinal study of the clinical and cellular outcomes of SI asthma is needed to more fully characterize the types and magnitude of risks associated with SI status.

Reliability and Validity of a System for Coding Asthma Outcomes from Medical Records

To evaluate the reliability and validity of a standardized asthma outcome coding system, we obtained medical records for 182 asthmatic children. Records were coded by trained staff using explicit and detailed criteria. Outcome variables coded included number of corticosteroid bursts, asthma-related physician contacts, emergency room visits, hospitalizations, and number of asthma episodes. Interrater reliability was excellent. Patterns of associations between the coded variables and other independently obtained outcome measures supported concurrent and construct validity. Given the intense scrutiny of health outcomes in the current managed-care marketplace, use of this system may foster further clinical research examining asthma outcomes.

Posttraumatic distress in children and families after intubation

Background: Posttraumatic stress disorder symptoms are seen in children who have experienced significant trauma. Respiratory arrest with subsequent intubation can be associated with terror, helplessness, and the threat of death. Methods: Three case reports are presented where emergency intubation was followed by symptoms of psychologic distress in the intubated child and his or her family members. Results: Although the medical literature documents posttraumatic distress symptoms after other medical procedures, this is the first account of symptoms following intubation. Children and other family members were found to have symptoms of reexperiencing the traumatic event, avoidance of thoughts or feelings related to the intubation, and hyperarousal. Issues around diagnosis and treatment are discussed. Conclusions: Children with a history of emergency intubation should be evaluated for possible posttraumatic stress disorder symptoms.

An investigation of the medical care utilization of children with severe asthma according to their type of insurance.

A comparison of the medical care utilization of children with severe asthma according to insurance type was performed. Subjects were grouped by which type of insurance they had: capitated, fee for service, or Medicaid insurance. Medical records were coded into utilization categories, by presenting complaint, sick- or well-child visit, and if a generalist or specialist provided care during the visit. The Medicaid group had less specialist, sick-child care than the groups with capitated or fee for service insurance. The Medicaid group also had more emergency room visits than the other two groups. The three groups had a similar amount of total physician/clinic visits. Even though similar care was shown to be available for those with Medicaid insurance, this low resource group often uses expensive emergency room care.