Mikael Thastum

Prevalence and Predictors of Emotional and Behavioural Functioning of Children Where a Parent Has Cancer A Multinational Study

This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design.

Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study

Objective The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child’s gender, type of anxiety disorder, initial severity and comorbidity, and parents’ psychopathology would significantly predict outcome. Method A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points. Results Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up. Conclusion SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.

Cold pressor pain : Comparing responses of Juvenile Arthritis patients and their parents

UNLABELLED The objective of this study was to compare the reactions to experimental cold pressor pain of Juvenile Arthritis (JA) patients, healthy children, and their parents. METHODS We compared pain threshold, discomfort, intensity, and tolerance to experimental cold pressor pain in 15 JA patients (age 9-15) and one of their parents and a control group of 25 healthy children (age 9-12) and one of their parents. RESULTS JA-patients exhibited significantly lower mean pain tolerance than healthy children. Pain tolerance correlated significantly with disease duration. Parents of JA-patients showed significantly greater mean pain intensity than parents of healthy children, and had higher estimates of their childs ability to endure pain than parents of healthy children. Correlations were found between pain scores of children and their parents for both pain intensity and tolerance. The pain coping category of Catastrophizing was associated with several of the experimental pain response measures. CONCLUSION The results suggest that JA patients may differ from healthy children with regard to their responses to experimental pain, and that pain responses of both JA patients and healthy children could be related to the pain response of their parents.

Barriers to adherence in adolescents and young adults with cystic fibrosis: a questionnaire study in young patients and their parents

Background Treatment adherence is crucial in patients with cystic fibrosis, but poor adherence is a problem, especially during adolescence. Identification of barriers to treatment adherence and a better understanding of how context shapes barriers is of great importance in the disease. Adolescent reports of barriers to adherence have been studied, but studies of their parents’ experience of such barriers have not yet been carried out. The aim of the present study was to explore barriers to treatment adherence identified by young patients with cystic fibrosis and by their parents. Methods A questionnaire survey of a cohort of young Danish patients with cystic fibrosis aged 14–25 years and their parents was undertaken. Results Barriers to treatment adherence were reported by 60% of the patients and by 62% of their parents. Patients and parents agreed that the three most common barriers encountered were lack of time, forgetfulness, and unwillingness to take medication in public. We found a significant positive correlation between reported number of barriers and perceived treatment burden. We also found a statistically significant relationship between the reported number of barriers and treatment adherence. A significant association was found between the number of barriers and the reactions of adolescents/young adults and those of their mothers and fathers, and between the number of barriers and the way the family communicated about cystic fibrosis. Conclusion The present study showed that the majority of adolescents with cystic fibrosis and their parents experienced barriers to treatment adherence. Agreement between adolescents and their parents regarding the level and types of barriers indicates an opportunity for close cooperation between adolescents, their parents, and health care professionals in overcoming adolescent adherence problems.

Evaluation of a Focused Short-term Preventive Counselling Project for Families with a Parent with Cancer

Twenty-four families participated in counselling for families with a parent with cancer (24 mothers, 17 fathers, and 34 children). Parents who received counselling were significantly more depressed before the counselling than a nonrandomized control group who did not receive counselling, but participated in another part of the project. For the parents, there was a significant decrease in depression and increase in family functioning scores from before to after the intervention. For the children, a significant pre-to post-decrease in depression scores was found. Changes in depression and family functioning were significantly correlated with the degree of counselling contentment. Reasons for seeking counselling were insecurity in relation to the children, problems with communication, high level of conflict, and change of roles. A number of themes appeared when parents and children described what they gained from the counselling: Confirmation in being a ‘good-enough’ parent, more understanding of emotions and reactions of other family members, more sense of intimacy and cohesion within the family, and normalization of own feelings.

Health-Related Quality of Life in Children and Adolescents Undergoing Surgery for Pectus Excavatum

INTRODUCTION This study evaluated health-related quality of life (HRQoL) in children and adolescents undergoing cosmetic surgery for pectus excavatum (PE) compared to a group of healthy children. METHODS The Intervention Group consisted of 172 children and adolescents undergoing surgery for PE between 2003 and 2005, aged 8-20 years; 86% were males. A postoperative follow-up study was conducted one to three years after surgery. None of the children had had the metal bar removed when they answered the questionnaires. The Control Group consisted of healthy schoolchildren (n=387), 201 females and 186 males (9-20 years).The generic health-related quality of life questionnaires, the Child Health Questionnaire CHQ-CF87 (child version), and CHQ-PF50 (parent version) were used in both groups. A Nuss assessment questionnaire modified for Adults (NQ-mA) and a single-step questionnaire (SSQ) on quality of life and health status were only used in the Intervention Group; these questionnaires also included questions about the remembered preoperative status. The response rates in the Intervention and Control Groups were 69% and 70%, respectively. RESULTS The HRQol was significantly better in the Intervention Group compared to the Control Group in 9 out of 14 subscales (CHQ-CF 87): General Health (p<0.05), Physical Functioning, Self-Esteem, Emotional Role, Role Functioning-Physical (p<0.01) and Mental Health, Family Activities, Bodily Pain, Role Functioning-Behavioral (p<0.001). The scores of the children and the parents correlated well in all subscales (rho range from 0.19-0.55, p<0.05-0.001) except for the Role Functioning-Physical scale (rho=0.17). Significant differences between the parent and child scores were found in six scales. The children reported significantly lower scores in Global Behavior, Global Health, Behavior (p<0.05), Bodily Pain (p<0.01), and Mental Health (p<0.001). The parents reported significantly lower scores in the Self Esteem scale (p<0.01). Self-esteem and body concept scored significantly higher postoperatively (p<0.001) in NQ-mA and SSQ. CONCLUSION HRQol was significantly better in the Intervention Group compared to healthy controls at the same age. In five subscales Self-Esteem, Behavior, Emotional Role, Mental Health and Family Activities, the PE group had a better HRQoL.

Reliability, validity and normative data for the Danish Beck Youth Inventories

This study examines reliability and validity and establish Danish norms for the Danish version of the Beck Youth Inventories (BYI) (Beck, Beck & Jolly, 2001), which consists of five self-report scales; Self-Concept (BSCI), Anxiety (BAI), Depression (BDI), Anger (BANI) and Disruptive Behavior (BDBI). A total of 1,116 school children and 128 clinical children, aged 7-14, completed BYI. Internal consistency coefficients were high. Most test-retest correlations were >0.70. A test-retest difference was found for BAI. Exploratory and confirmatory factor analysis indicated that the five factor structure of the instrument was justified. The BSCI, BAI and BDI discriminated moderately between the norming sample and the clinical group, and the latter group included more children who exceeded the 90th percentile of the norming sample. Diagnostic groups scored higher on relevant scales than norms. Only BSCI and BDI differentiated between diagnostic groups. The BYI showed acceptable internal consistency and test-retest stability, except for BAI. The BYI did not adequately differentiate between internalizing disorders.

A Danish adaptation of the Pain Coping Questionnaire for children: preliminary data concerning reliability and validity.

The aim of this study was to determine the reliability and validity of a Danish translation of the Pain Coping Questionnaire (PCQ) for children in Danish children. The PCQ was translated using a translation‐back‐translation method. The subjects were 352 healthy children and 40 children with juvenile arthritis (JA), aged 8–17 y. Sixteen of the JA children were divided into a high‐pain group (n= 7) and a low‐pain group (n= 9). The results were factor analysed using principal component analysis with varimax rotation. Clinical pain intensity was measured using visual analogue scales (VAS) from the Varni/Thompson Pediatric Pain Questionnaire. Experimental pain was induced using a cold pressor pain paradigm and outcome measures were pain intensity, pain discomfort and tolerance to cold pressor pain. A seven‐factor solution emerged as the most consistent factor structure. Four subscales, Seeking Social Support (SSS), Cognitive Distraction (CD), Externalizing (EXT) and Internalizing/Catastrophizing (INT), corresponded with the parallel subscales proposed by Reid et al. (Pain 1998; 76: 83–96). Two subscales, Positive Self‐Statements (PSS) and Behavioral Distraction (BD), were composed of four of the five items from the previously proposed subscales. One subscale, Information Seeking/Problem Solving (IP), consisted of items from two subscales proposed by Reid et al., i.e. Information Seeking and Problem Solving. Internal consistencies of the subscales were acceptable, with reliability coefficients ranging from 0.60 (BD) to 0.83 (IP) and with test‐retest reliabilities between 0.59 and 0.78. Low‐pain JA patients showed significantly higher levels of BD than High‐pain JA patients (p < 0.05). Greater utilization of PSS and BD was associated with less patient‐reported present pain and less average everyday pain (p < 0.05‐0.01), and greater utilization of INT was significantly associated with higher experimental pain intensity (p < 0.01). These preliminary findings provide support for the reliability and validity of the Danish modification of the PCQ in a Danish population and for the hypothesis that paediatric pain‐coping strategies are associated with the intensity of clinical and experimental pain.

Psychosocial problems in children with cystic fibrosis

Aim: To compare the well‐being of children (7–14 years) with cystic fibrosis (CF) (n = 43) with the well‐being of healthy controls (n = 1121).

Decreased Pain Threshold in Juvenile Idiopathic Arthritis: A Cross-sectional Study

Objective. To examine the pain threshold in children with juvenile idiopathic arthritis (JIA) compared with healthy children by using a digital pressure algometer. Methods. Fifty-eight children with JIA born between 1995 and 2000 and 91 age-related healthy children participated in the study. We used a digital pressure algometer to measure the pain threshold on 17 symmetric, anatomically predefined joint-related or bone-related areas. All children were asked to rate their current pain on a Faces Pain Scale, and parents of children with JIA were asked to complete a parental revised version of the Child Health Assessment Questionnaire (CHAQ-R). Clinical data were registered on children with JIA. Results. The pain threshold was significantly lower among children with JIA (total mean PT = 1.33 ± 0.69 kg/cm2) when compared with the healthy control group (total mean PT = 1.77 ± 0.67 kg/cm2). The same pattern was found in all areas measured, including negative control areas that are normally unaffected in JIA (p = 0.0001 to 0.005). Overall, the pain threshold was 34% lower in females than in males in both groups (p < 0.0001). We found no correlation between pain threshold and age, current pain experience, disease duration, or disease activity. Conclusion. Children with JIA had a substantially lower pain threshold even in areas usually unaffected by arthritis. Our findings suggest that JIA alters the pain perception and causes decreased pain threshold.