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WORLD HOSPITAL DIRECTORY
Pediatrics Medical Journal of Pediatric Psychology - current issue
<span class="paragraphSection">Significant progress has been made in advancing caregiver wellbeing research and clinical application in the last decade (<a href="#jsaf019-B12" class="reflinks">Salley et al., 2024</a>). This commentary on the work of <a href="#jsaf019-B15" class="reflinks">Badovinac et al. (2024)</a> will highlight the importance of more comprehensively examining context in caregiver responses. Caregivers live within the push and pull between social and family demands, and it is vital to expand our view to gain a more comprehensive understanding of their experience. Consequently, the methodology of future studies with caregivers must reflect those demands and complexities.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Despite a rise in pet ownership and adult literature indicating pet co-sleeping may lead to disrupted sleep, limited research has evaluated the impact of youth co-sleeping with an animal. This study evaluated whether a pet in the bedroom affects youth sleep.<div class="boxTitle">Methods</div>175 families completed measures of screen time, sleep problems, and parental sleep knowledge. Youth (<span style="font-style:italic;">M</span> age = 9.51; 53.1% male) wore an ActiGraph and completed a sleep diary for 2 consecutive weeks. For youth who owned a pet dog, the dog wore an ActiGraph for the same 2 weeks. Youth were separated into 3 groups: those who slept with a pet on the bed, those with a pet in the room but not on the bed, and those with no pet in the bedroom.<div class="boxTitle">Results</div>Results suggest that youth with a pet on the bed have a shorter sleep duration, lower efficiency, and longer sleep onset latency than youth without a pet in the bedroom. A pet on the bed explained unique variance in sleep efficiency, duration, and latency when accounting for factors previously shown to impact youth sleep. Awakenings and self-reported sleep problems did not differ between groups. In dyadic analyses (<span style="font-style:italic;">n </span>=<span style="font-style:italic;"> </span>43), dog movement 1 min prior predicted child movement at night.<div class="boxTitle">Conclusions</div>Results suggest that having a pet on the bed is associated with more restless and shorter sleep. Though results should be replicated, clinicians should begin assessing pet sleeping location when addressing sleep concerns and provide families with information about the potential impact of pets on sleep.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Young children at-risk for attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, which may exacerbate ADHD symptoms and related impairment. Yet, little is known about modifiable factors associated with the maintenance of sleep problems. This study examined the relationships among parenting practices, behavioral self-regulation skills, and sleep functioning in young children at-risk for ADHD.<div class="boxTitle">Methods</div>Caregivers (94.2% female; 82.6% White) of 121 young children at-risk for ADHD (<span style="font-style:italic;">M</span><sub>age</sub> = 4.04 years; 70.2% male; 71.9% White; 20.3% Hispanic) completed measures of parenting practices and child sleep. Children completed a lab-based task that measured behavioral self-regulation skills. Only pre-treatment data (before the delivery of behavioral parent education) were used for the study.<div class="boxTitle">Results</div>Greater use of adaptive parenting strategies, but not child behavioral self-regulation, was associated with decreased bedtime resistance after controlling for caregivers’ marital status and education level. Additionally, adaptive parenting strategies moderated the relationship between child behavioral self-regulation and sleep distress, such that children with low behavioral self-regulation experienced less sleep distress when caregivers utilized more adaptive parenting strategies compared to caregivers who utilized less adaptive parenting strategies.<div class="boxTitle">Conclusions</div>For pediatric health providers working with families with young children at-risk for ADHD presenting with sleep problems, psychoeducation on adaptive parenting practices as well as encouraging parents to utilize these strategies may potentially improve child sleep functioning.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Type 1 diabetes (T1D) disease management and associated glycemic fluctuations can disrupt experiences of hunger and satiety, which may increase risk for disordered eating behaviors. Glycemic variability may be a useful trigger for just-in-time interventions for disordered eating behaviors. In this exploratory study, we hypothesized that two metrics of glycemic variability would be associated with greater hunger and predict eating behaviors for weight loss or maintenance in adolescents and young adults with T1D.<div class="boxTitle">Methods</div>Individuals with T1D were recruited from a university diabetes clinic (<span style="font-style:italic;">N </span>=<span style="font-style:italic;"> </span>34; 50% female, <span style="font-style:italic;">M</span><sub>age</sub> = 19.53 years, <span style="font-style:italic;">M</span><sub>HbA1c</sub> = 7.98%; 29% Hispanic/Latinx; 79% White). Participants wore a blinded continuous glucose monitor for 5 days, and completed ecological momentary assessments (four prompts per day) that included measures of hunger and eating behaviors for weight loss or maintenance purposes. Generalized and linear mixed models were used to test hypotheses.<div class="boxTitle">Results</div>Approximately 30% of participants were at risk for an eating disorder based on Diabetes Eating Problem Survey—Revised scores. Greater glycemic variability did not predict hunger, but was associated with increased odds of endorsing any eating behavior for weight loss or maintenance purposes within-person (<span style="font-style:italic;">p</span>s<.05). Greater hunger was associated with increased odds of endorsing disordered eating behavior within-person (<span style="font-style:italic;">p</span><.05).<div class="boxTitle">Conclusions</div>This exploratory study provides some preliminary evidence that times of greater hunger and glycemic variability may be when individuals with T1D may be at higher risk of engaging in behaviors to lose or maintain weight.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>There is a need for a systematic review on social functioning and peer relationships among adolescents with chronic pain (ACP) given the high prevalence of chronic pain in adolescence and integral role of peer relationships in adolescent development. This review aims to examine the methods used to evaluate social functioning, the types and extent of peer relationship difficulties, and pain characteristics and sociodemographic factors related to social functioning in ACP.<div class="boxTitle">Methods</div>A systematic literature search of PubMed, PsycINFO, CINAHL, Web of Science, and Cochrane databases was performed. Included studies were written in English, presented original, quantitative, peer-reviewed research, had a primary focus on social functioning or peer relationships in ACP, and included study participants between the ages of 10 and 18 years. The review was registered in PROSPERO (No. CRD42022364870).<div class="boxTitle">Results</div>Twenty-eight articles were included in the review. All studies used self-, parent-, or peer-report questionnaires to evaluate social functioning. Most (89%) of the studies were cross-sectional. Findings suggest that ACP experience social difficulties frequently characterized by loneliness, social anxiety, withdrawal, and peer victimization. Studies examining the associations between social functioning and sociodemographic variables, pain location, and pain-related characteristics yielded mixed findings. Study quality was mixed, with 57.14% rated as “good.”<div class="boxTitle">Conclusions</div>Findings from this review emphasize the increased risk of reduced social connectedness and the complexity of underlying mechanisms associated with poorer social functioning among ACP. Additional research utilizing longitudinal methodologies is needed to understand potential moderators and directionality of associations between chronic pain and social functioning.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Adolescent emotion regulation (ER) has been positively linked to caregiver–adolescent sexual communication. With ER becoming increasingly conceptualized as an interpersonal process, it is likely that both adolescent <span style="font-style:italic;">and</span> caregiver ER impact communication patterns to some extent; thus, each must be accounted for in scientific inquiry and intervention approaches. We aimed to identify distinct profiles of caregiver and adolescent ER and examine how each profile is differentially related to caregiver–adolescent communication about sexual health and relationships.<div class="boxTitle">Methods</div>Participants included adolescent males (<span style="font-style:italic;">n </span>=<span style="font-style:italic;"> </span>117; <span style="font-style:italic;">M</span><sub>age</sub> = 13.06; <span style="font-style:italic;">SD</span> = 0.72) and their caregivers (<span style="font-style:italic;">M</span><sub>age</sub> = 42.33; <span style="font-style:italic;">SD</span> = 0.72) who were recruited as part of a dyadic, web-based dating violence prevention intervention trial for middle school boys.<div class="boxTitle">Results</div>Using a self-report measure, three clusters were identified: families with Moderate ER strategy use (by both parents and adolescents), families with Low ER strategy use (by both parents and adolescents), and families with Mixed ER strategy use (moderate adolescent but low caregiver ER strategy use). Caregivers in the Moderate ER strategy use cluster reported discussing the greatest total number of sexual health and relationship topics. Adolescents in the Mixed ER strategy use cluster indicated the greatest perceived caregiver openness during discussions.<div class="boxTitle">Conclusions</div>Findings suggest that adolescent ER may more strongly influence positive patterns of communication regarding sexual health and relationships than parent ER. Future research should compare the efficacy of adolescent sexual health and dating interventions with adolescents alone versus dyadic interventions to determine whether there is a clinically significant additive effect of including caregivers or if adolescent engagement alone may suffice.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Social-ecological factors are highly congruent with social determinants of health (SDOH): Economic Stability; Educational Access/Quality; Healthcare Access/Quality; Neighborhood/Built Environment; and Social/Community Context. In this topical review, the correspondence of social-ecological theory with SDOH and assessment approaches is reviewed. The Psychosocial Assessment Tool (PAT) is used to show how existing tools may facilitate SDOH screening.<div class="boxTitle">Methods</div>SDOH are defined, and their link to pediatric health outcomes is presented, followed by a review of the social-ecological model. Feasible, valid, and actionable approaches to assessment of social ecology <span style="font-style:italic;">and</span> SDOH are presented with a focus on the PAT, a brief caregiver report screener based on social-ecological theory, validated in English, Spanish, and in multiple conditions and adapted/translated internationally. Multidisciplinary healthcare providers (<span style="font-style:italic;">n</span> = 25) completed an online survey, indicating whether each PAT item fit into SDOH categories.<div class="boxTitle">Results</div>Despite different approaches to assessing SDOH, there are few feasible and evidence-based approaches. Most PAT items (78%) were consistent with one of the SDOH categories by the majority of raters. PAT items corresponded to all five SDOH categories. Some items about child behavior and family were not categorized as an SDOH, reflecting the broader context of screening with the PAT.<div class="boxTitle">Conclusion</div>The assessment of SDOH is a priority, but approaches to assessment and linking outcomes to intervention remain underdeveloped. As an evidence-based screener in pediatric healthcare, based on social-ecological and public health models, the PAT may provide a means of identifying relevant SDOH in pediatric practice.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>This study investigated biological, psychological, and behavioral aspects of caregivers’ responses to toddlers’ pain-related distress by measuring caregivers’ high-frequency heart rate variability (HRV) responses during toddler vaccination pain and examining associations with caregivers’ behavioral responses and psychological stress.<div class="boxTitle">Methods</div>Participants included caregiver–toddler dyads (<span style="font-style:italic;">N </span>=<span style="font-style:italic;"> </span>194) from a longitudinal cohort-sequential study who were observed during toddlers’ 12-, 18-, or 24-month routine vaccinations. Changes in caregiver HRV were analyzed using growth curve modeling. Conditional growth curve models examined associations between caregiver HRV and caregivers’ concurrent behavior and psychological stress.<div class="boxTitle">Results</div>The unconditional growth curve model indicated a slight linear decrease in caregiver HRV (i.e., vagal withdrawal) across the 3 min post-needle (unstandardized <span style="font-style:italic;">B</span> = –0.06, <span style="font-style:italic;">p</span> = .049). In conditional growth curve models, higher levels of parenting stress were associated with less vagal withdrawal during the post-needle period (standardized <span style="font-style:italic;">B</span> = 0.47, unstandardized <span style="font-style:italic;">B</span> = 0.02, <span style="font-style:italic;">p</span> = .003). Caregivers’ behavioral responses (i.e., use of soothing and distress-promoting behaviors), state anxiety, and general anxiety symptomology were not significantly associated with HRV responses.<div class="boxTitle">Conclusions</div>Caregiver parasympathetic nervous system activity levels changed minimally from baseline to post-needle and decreased slightly across the post-needle period. Caregivers’ self-reported parenting stress was associated with their parasympathetic responses to the procedure. Findings support an improved understanding of the mechanisms underlying caregivers’ responses to children’s pain-related distress in a naturalistic setting.</span>
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