Lizette Peterson

Coping by Children Undergoing Stressful Medical Procedures: Some Conceptual, Methodological, and Therapeutic Issues.

Because coping is postulated to change across persons, time, and stressors, the study of coping is inherently complex. These complexities are magnified in childrens coping because a childs ability to effectively appraise a stressor and the coping resources that are available is dependent on the childs rapidly shifting developmental level. A small set of recent pediatric psychology studies describes childrens active, informative-seeking coping versus avoidant or information-denying coping as an example of current trends in research on childrens coping. Review of these studies highlights the need for tighter, more complete conceptualizations and improved methodologies. There are many therapeutic implications of this research, not the least of which is the problem of how (or even if) avoidant children should be prepared for medical procedures.

Integrating child injury and abuse-neglect research: common histories, etiologies, and solutions

Research on injuries, the leading health threat to children in the United States, has been infrequent and badly fragmented. Research on unintentional injuries and research on abuse-neglect have similar histories, including recent rapprochement with behavioral interventions, and reveal similar etiologies for child injury. Further, recent studies document difficulties in discriminating between unintentional and abuse-neglect-related injuries. The areas also face similar methodological and conceptual challenges. Finally, the same interventions may prevent negative outcomes in both areas. A working model to summarize a more integrated approach to injury prevention is offered. Increasing societal awareness of the threat posed by injuries and strengthening mutually applicable strategies of injury prevention would be sought-after results of unifying efforts in these historically isolated arenas.

An information seeking disposition in child surgery patients.

Several studies in the last decade have demonstrated the importance of considering an information seeking versus information avoiding coping dimension in adult medical patients. However, there have been few empirical demonstrations of such a dimension in children. The present study utilized the Coping Strategies Interview to assign an information seeking score to child elective surgery patients. This information seeking score was related to several parent-rated variables, including the childs historical success in coping with medical procedures, the childs typical preference for information acquisition, and the childs typically emitted coping behaviors. In addition, the information seeking score was related to question asking and discussion of medical procedures as rated by an objective observer during the blood test, by the nurse during anesthesia induction, and by the parent during recovery from surgery. It was strongly related to the information acquired prior to hospitalization. Information seeking was also related to stress responses, such that high information seeking scores predicted more adaptive behaviors prior to the blood test. This cross-rater and cross-situation validation suggests the existence of an information seeking dimension in children and the utility of considering this dimension in future research.

Injury risk factors in children with attention deficit hyperactivity disorder.

Processes related to injury in children with Attention Deficit Hyperactivity Disorder (ADHD) were examined. Two groups of 7-11-year-old boys (14 ADHD and 16 controls) watched a videotape simulating play activities in order for them to identify risky behaviors and then answered questions about risky scenes. Groups did not differ in ability to identify hazards, but children with ADHD anticipated less severe consequences following risky behavior and reported fewer active methods of preventing injury than did controls. Cognitive factors, including lower expectations of personal risk in hazardous situations and less ability to generate prevention strategies and safety rules, may contribute to increased injury liability in boys with ADHD. Language: en

SURVEY OF PEDIATRIC HOSPITALS' PREPARATION PROGRAMS : EVIDENCE OF THE IMPACT OF HEALTH PSYCHOLOGY RESEARCH

A survey of all 123 nonchronic-care pediatric hospitals in the United States revealed that 75% of hospitals responding had greatly increased the use of effective medical procedure preparation technologies, such as filmed modeling and coping skills instruction, in comparison to the last survey. Respondent characteristics such as position (e.g., nurse, child life worker, physician), degree (e.g., RN, MA, PhD), and length of time in the position failed to predict the type of techniques selected, but higher respondent knowledge and more psychological sources of preparation information did predict the use of preparation techniques used for drawing blood that experts rated as more effective. Challenges for more effective dissemination of research in the future are considered, as is the need for increased study of research-implementation links.

Childhood depression: Peer reactions to depression and life stress

The present study investigated childrens responses to a peers childhood depression. Younger children in third and fourth grade and older children in fifth and sixth grade were exposed to one of four films. The four films portrayed a female peer who was either depressed or not depressed and who had experienced numerous recent life stresses or no recent life stress. Overall, children rated the depressed peers as less likable and attractive, as engaging in fewer positive current and future behaviors, and as needing therapy more than a nondepressed peer. There was a tendency to rate the depressed peer with high life stress more positively than the depressed peer with low life stress; this tendency decreased with age. Girls rated all of the peers and especially the stressed peers more positively than did the boys. The results are discussed in terms of the implications of childrens social interaction for the initiation or maintenance of childhood depression.

Preparation for stressful medical procedures and person × treatment interactions

Abstract Research on preparation for medical procedures has progressed from static situation-based or person-based explanations of responding to a more interactional perspective which considers person-by-situation interactions. This review considers examples from four basic approaches to preparation for stressful medical procedures, including the provision of procedural information, sensory information, coping instruction, and modeling. Person characteristics such as gender, and traits such as locus of control, trait anxiety, and coping style are then presented, and their direct influence and interactive influence with treatment are described. Finally, research techniques which may result in increased integration of this rapidly growing area are proposed.

Family processes and child risk for injury

Although injuries are the leading health threat to children, behavioral interventions within the family to prevent injuries remain relatively unexplored. In this paper, the parenting literature relevant to maltreatment injuries is reviewed in order to offer a broader picture of the potential influence of the family on all kinds of injuries. Factors that influence parental supervision of risky child behavior, relationship issues that may potentiate risky behavior, and the role of behavioral rules in reducing risky responding are considered. Suggestions for future research on family processes in injury socialization and intervention options are advanced.

Differential reinforcement of other behavior: A preferred response elimination procedure

Ethical and legal concerns which have been raised regarding many types of response elimination techniques are discussed, and the increased use of a schedule employing positive reinforcement to eliminate behavior is proposed. The differential reinforcement of other behavior (DRO) schedule is compared with other response elimination techniques. It is concluded that DRO schedules compare favorably with other techniques in speed and completeness of response elimination. In addition, DRO schedules may be superior to other techniques in durability and generalization of response reduction and in the type of side effects produced. Increased examination and use of DRO schedules is urged.

Parental problem-solving skills, stress, and dietary compliance in phenylketonuria.

Parents of 30 children with phenylketonuria (PKU) who were classified as being in good dietary control (compliant, measured as within the medically acceptable range of blood phenylalanine levels of 2-10 mg) or poor dietary control (noncompliant, measured as either below or above medically acceptable 2-10 mg blood phenylalanine levels) engaged in verbal and written problem-solving situations under conditions of both high and low time-pressure induced stress. Overall, compliant parents gave higher quality verbal and written problem-solving solutions than noncompliant parents. Stress reduced the quality of problem solving in both compliant and noncompliant parents, but even under high stress, compliant parents demonstrated better problem-solving abilities than noncompliant parents. The potential importance of these findings for preventive intervention in PKU families is discussed.