Trude Reinfjell

Measuring health-related quality of life in young adolescents: Reliability and validity in the Norwegian version of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL) generic core scales

BackgroundHealth-Related Quality of Life (HRQOL) studies concerning children and adolescents are a growing field of research. The Pediatric Quality of Life Inventory (PedsQL™) is considered as a promising HRQOL instrument with the availability of age appropriate versions and parallel forms for both child and parents. The purpose of the current study was to evaluate the psychometric properties of the Norwegian translation of the Pediatric Quality of Life Inventory (PedsQL™) 4.0 generic core scale in a sample of healthy young adolescents.MethodsA cross-sectional study of 425 healthy young adolescents and 237 of their caregivers participating as a proxy. Reliability was assessed by Cronbachs alpha. Construct validity was assessed using exploratory factor analysis and by exploring the intercorrelations between and among the four PedsQL subscales for adolescents and their parents.ResultsAll the self-report scales and proxy-report scales showed satisfactory reliability with Cronbachs alpha varying between 0.77 and 0.88. Factor analysis showed results comparable with the original version, except for the Physical Health scale. On average, monotrait-multimethod correlations were higher than multitrait-multimethod correlations. Sex differences were noted on the emotional functioning subscale, girls reported lower HRQOL than boys.ConclusionThe Norwegian PedsQL is a valid and reliable generic pediatric health-related Quality of Life measurement that can be recommended for self-reports and proxy-reports for children in the age groups ranging from 13–15 years.

Resilience as a Predictor of Depressive Symptoms: A Correlational Study with Young Adolescents:

This correlational study explored the Resilience Scale for Adolescents (READ)1 as a predictor for developing depressive symptoms controlling for known risk factors. A young adolescent sample (N = 387) completed the READ, the Short Mood and Feeling Questionnaire (SMFQ), Social Phobia Anxiety Index for Children (SPAI-C), and the occurrence of Stressful Life Events (SLE). In addition, a subsample of their parents (N = 240) completed a parental version of READ (READ-P). The results indicated that the READ assesses important protective factors that are associated with fewer depressive symptoms among young adolescents even when controlling for known risk factors. All five READ-factors were predictors of depressive symptoms, while the READ-P showed no predictive value. There were no significant interaction effects between READ and SLE. There were, however, significant main-effects supporting a compensatory model of protective factors. The findings suggest that the READ is a significant predictor of mental health and a useful tool for further research examining differences in stress tolerance among young adolescents.

Cognitive outcome in children and adolescents treated for acute lymphoblastic leukaemia with chemotherapy only

Objective: To examine cognitive outcome in children and adolescents with acute lymphoblastic leukaemia (ALL) in remission, treated with central nervous system prophylactic chemotherapy only.

Health‐related quality of life and intellectual functioning in children in remission from acute lymphoblastic leukaemia

Aim: To evaluate the health‐related quality of life (HRQOL) and intellectual functioning of children in remission from acute lymphoblastic leukaemia (ALL).

Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioning

Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioningThe objective of this study is to assess the mental health and psychosocial adjustment of children in remission from acute lymphoblastic leukaemia (ALL), and parental functioning compared to healthy controls. A cross-sectional study of 40 children treated for ALL (mean age 11.8 years, range 8.5-15.4) and healthy controls (n = 42) (mean age 11.8 years, range 8.11-15.0) were assessed by the Child Behaviour Checklist (CBCL), the Youth Self-Report (YSR) and the Strength and Difficulties Questionnaire (SDQ). The parents own mental health was assessed by the General Health Questionnaire (GHQ-30). Children treated for ALL showed on average significantly more symptoms as measured by the CBCL Total Behaviour Score for mothers report (P = 0.005), and for fathers report (P = 0.004) compared with healthy children. Fathers reported more anxiety (P = 0.03) and depression (P = 0.02) as measured by the GHQ-30 compared with healthy controls. Children in remission from ALL showed on average significantly more problems regarding mental health and psychosocial adjustment, as reported by their parents, compared with healthy controls. Adequate rehabilitation and follow-up programmes should be implemented for children in remission from ALL. The results indicate the need to pay attention to the mental health of fathers during the rehabilitation phase.

The Pediatric Quality of Life Inventory (PedsQL™) 4.0 as an assessment measure for depressive symptoms: A correlational study with young adolescents

Health-related quality of life (HRQOL) is today considered an important assessment measurement, but still only a few measures assess HRQOL outcomes for children and adolescents. One of them is the Pediatric Quality of Life Inventory (PedsQL™). This correlation study explored the associations between depressive symptoms in young adolescents and the PedsQL scores when controlling for known risk factors. An adolescent sample (n=425) completed a battery of measures including the PedsQL™ Norwegian version, the Short Mood and Feeling Questionnaire (SMFQ), the Social Phobia and Anxiety Inventory for children (SPAI-C), and the occurrence of Stressful Life Events (SLE). The results showed a mild to moderate correlation between the measures PedsQL, SMFQ, SPAI-C and SLE. The presence of depressive symptoms significantly predicted the PedsQL scores for the adolescence, and explained 17% of the variance in outcome for the PedsQL Total Scale. The findings suggest that the PedsQL™ is an adequate assessment instrument regarding depressive symptoms in young adolescents, and can be useful in both clinical practice and further research as an assessment measure regarding childrens mental health.

Resilience factors play an important role in the mental health of parents when children survive acute lymphoblastic leukaemia.

Childhood cancer is a tremendous stressor that requires parents to adapt to new challenges, and research has mainly focused on psychopathology and rarely on a resource‐oriented perspective, such as resilience. This study assessed resilience factors among parents of children surviving acute lymphoblastic leukaemia and parents of healthy children. We also explored the association between parental resilience and mental health.

Predictors of change in depressive symptoms from preschool to first grade

Childrens depressive symptoms in the transition from preschool to school are rarely investigated. We therefore tested whether childrens temperament (effortful control and negative affect), social skills, child psychopathology, environmental stressors (life events), parental accuracy of predicting their childs emotion understanding (parental accuracy), parental emotional availability, and parental depression predict changes in depressive symptoms from preschool to first grade. Parents of a community sample of 995 4-year-olds were interviewed using the Preschool Age Psychiatric Assessment. The children and parents were reassessed when the children started first grade (n = 795). The results showed that DSM-5 defined depressive symptoms increased. Child temperamental negative affect and parental depression predicted increased, whereas social skills predicted decreased, depressive symptoms. However, such social skills were only protective among children with low and medium effortful control. Further, high parental accuracy proved protective among children with low effortful control and high negative affect. Thus, interventions that treat parental depression may be important for young children. Children with low effortful control and high negative affect may especially benefit from having parents who accurately perceive their emotional understanding. Efforts to enhance social skills may prove particularly important for children with low or medium effortful control.

A Review of Demographic, Medical, and Treatment Variables Associated with Health-Related Quality of Life (HRQOL) in Survivors of Hematopoietic Stem Cell (HSCT) and Bone Marrow Transplantation (BMT) during Childhood.

Hematopoietic stem cell transplantation (HSCT) is a standard treatment after disease relapse and failure of conventional treatments for cancer in childhood or as a first line treatment for some high-risk cancers. Since hematopoietic stem cells can be found in the marrow (previously called a bone marrow transplantation) or periphery, we refer to HSCT as inclusive of HSCT regardless of the origin of the stem cells. HSCT is associated with adverse side effects, prolonged hospitalization, and isolation. Previous studies have shown that survivors of HSCT are at particularly high risk for developing late effects and medical complications, and thus, in addition to survival, quality of life in survivors of HSCT is an important outcome. This review summarizes and distills findings on the health-related quality of life (HRQOL) of long-term childhood cancer survivors of HSCT and examines significant sociodemographic, medical, disease and treatment correlates of HRQOL, as well as the methodology of the studies (instruments, type of studies, timing of assessment, type of transplantation). Because previous reviews covered the studies published before 2006, this review searched three databases published between January, 2006, and August, 2016. The search identified nine studies, including 2 prospective cohort studies and 7 cross-sectional studies. All studies reported a follow-up time of >5 years. The review found that HRQOL is significantly impacted over time following childhood HSCT, with salient correlates of HRQOL found to be presence of a severe chronic health or major medical condition, graft vs. host disease (GVHD), or pain. Continual evaluation of HRQOL must be integrated into long-term follow-up after childhood HSCT, and intervention should be offered for those survivors with poor HRQOL. Longitudinal studies should be emphasized in future research to allow for predictor models of resilience and poor HRQOL.

Pre-procedure Evaluation and Psychological Screening of Children and Adolescents in Pediatric Clinics

Children with severe and/or chronic medical diseases, congenital malformations, and functional impairments have significantly increased risk of developing mental, psychosocial, and family-related problems because of the disease process or different stressful, painful, or traumatic medical treatment procedures. Current studies also demonstrate that pain remains undertreated in children. Hospital personnel need to increase their knowledge of the psychological consequences of serious illness in children so posttraumatic stress reactions can be more effectively prevented. Children present a great challenge because it is necessary to consider their age, developmental level, cognitive and communication skills, previous pain experiences, and associated beliefs. This chapter focuses on factors influencing children’s understanding of and adaptation to severe illness and treatment procedures. We will address factors that are important in the pre-procedure evaluation, discuss relevant interventions and screening tools, and present case examples.