Feasibility Study of Back2School, a Modular Cognitive Behavioral Intervention for Youth With School Attendance Problems.

There is large heterogeneity among youth with school attendance problems (SAPs). For this reason, protocols for the treatment of SAPs need to be flexible. Back2School (B2S) is a new manual-based, modular transdiagnostic cognitive behavioral intervention to increase school attendance among youth with SAPs. It also aims to increase the self-efficacy of these youth and their parents. B2S includes evidence-based modules addressing youth anxiety, depression, and behavior problems, together with modules focused on parent guidance and school consultation. The current study examined the feasibility of evaluating B2S in an randomized controlled trial and acceptability of the B2S program in a non-randomized trial, including both qualitative and quantitative data, in preparation for a randomized controlled trial of its effectiveness. Youth, parents, and teachers completed questionnaires at baseline, post-intervention, and follow-up. School attendance data were collected from school registers. Twenty-four youth with a SAP (defined as more than 10% absenteeism during the last 3 months) were recruited from primary and lower secondary schools in Aarhus Municipality, Denmark. Their parents also participated in B2S. Two of the 24 families withdrew during the intervention, after sessions two and six respectively. Of the remaining 22 families, 19 (86%) completed all 10 sessions. Parents and youth rated their satisfaction with B2S as high, and high levels of satisfaction were maintained 1 year after the intervention. Teacher satisfaction was lower than that of youth and parents, but the majority found the school's participation in the intervention helpful. Preliminary evaluation of intervention outcomes showed significant increase in school attendance and decrease in psychological symptoms, as well as a significant increase in self-efficacy for both youth and parents. Based on this feasibility data, adaptations were made to the B2S manual and study procedures prior to commencement of a randomized controlled effectiveness trial. The main adaptation to the manual was to increase school consultation. The main procedural adaptation was to broaden recruitment. Furthermore, it was necessary to increase level of staffing by psychologists because treatment delivery was more time consuming than expected.

The Back2School modular cognitive behavioral intervention for youths with problematic school absenteeism: study protocol for a randomized controlled trial.

BACKGROUND: School absenteeism (SA) is associated with anxiety, depression, and disruptive behavior. It is a risk factor for academic difficulties and school dropout, which predict problems in adulthood such as social, work-related, and health problems. The main goal of this study is to examine the initial effectiveness of a modular transdiagnostic cognitive behavioral therapy (CBT) intervention (Back2School) for increasing school attendance and decreasing psychological problems, relative to a comparator control arm (treatment as usual [TAU]). METHODS/DESIGN: One hundred sixty children, aged 7 to 16 years, will be randomly assigned to either Back2School or TAU. The design is a two (Back2School and TAU) by four (preassessment [T1], postassessment [T2], and 3-month [T3] and 1-year [T4] assessments) mixed between-within design. The primary outcome is school attendance based on daily registration. Secondary outcomes pertain to youth psychosocial functioning, quality of life, bullying, self-efficacy, and teacher-parent collaboration. These secondary outcomes are measured via youth, parent, and teacher reports. DISCUSSION: This study will provide critically needed empirical evidence on the initial effectiveness of a manualized treatment program for youth with SA. If the intervention is found to be effective, the program can be further implemented and tested in a larger school health effectiveness trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03459677 . Retrospectively registered on 9 March 2018.

A prospective study on quality of life in youths after pectus excavatum correction.

BACKGROUND: The impact of correction of pectus excavatum (PE) on adolescents' health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group. METHODS: Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE. A control group (n=183) consisting of school children comparable in age completed the same measure on one occasion. RESULTS: The patients' level of HRQL before surgery was comparable to the level of the controls except for physical functioning; here boys reported impaired function compared to controls (P<0.0001, d=0.72). Both patients and parents reported improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre- to post-surgery. These improvements were statistically significant (P≤0.001-0.03) and yielded moderate to high effect sizes (ƞ2=0.04-0.22). CONCLUSIONS: The improvement of physical and psychosocial HRQL reported by both patients and their parents as proxy indicates the psychological implications of the deformity. Patients reported impaired physical function compared to controls. Further, pre-surgery differences in HRQL between the patients and the controls were lacking. However, the improvement in the patients' HRQL following surgery may justify the correction of pectus excavatum. The effect of the deformity on patients wellbeing compared with controls' needs to be addressed in further studies.

Cognitive behavioral group intervention for pain and well-being in children with juvenile idiopathic arthritis: a study of feasibility and preliminary efficacy.

BACKGROUND: Pain is still a part of everyday living for several children with juvenile idiopathic arthritis (JIA) despite improvement in treatment. Psychological interventions may contribute to diminish pain complaints and improve well-being in children with JIA. Only few studies have investigated the efficacy of psychological therapy in children with arthritis and with mixed results. The aim of the study was to evaluate the feasibility and preliminary efficacy of a cognitive behavioral therapy group intervention for children with JIA and their parents. METHODS: Nineteen children with JIA and their parents were allocated to six sessions' group cognitive-behavioral therapy (n = 9) or a waitlist control condition (n = 10). Results were measured from self-reported scales and one-week pain diaries. Clinical data was collected by a rheumatologist. RESULTS: The participation rate was low; 33 % of the invited families participated. However, the participants rated the intervention's credibility and satisfaction with the intervention as high. The dropout rate was low and attendance rate high. Increased quality of life and improvements in adaptive pain cognitions was reported in the intervention condition compared to the waitlist condition, whereas no differences were found for pain and functional disability. The disease activity increased in the treatment condition but not in the control condition. CONCLUSIONS: The feasibility of this study seemed high with regards to the acceptability of the families participating in the intervention. However, the feasibility in general was challenged by implementation problems with a low participation rate. A reduction in pain after the intervention was not found even though pain management was the main target in the intervention. Preliminary analysis showed that although the severity of the disease status increased, an increase in quality of life, reduction in pain catastrophizing, and an improvement in adaptive pain cognitions (the beliefs in controlling pain and self-efficacy) were seen in the intervention condition. The study highlights the importance of considering the disease status when evaluating the efficacy of a psychological intervention in children with arthritis. Conclusions on the strength of the efficacy require further research in a large, randomized controlled trial.

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/cm(2)) when compared with the healthy control group (total mean PT = 1.77 ± 0.67 kg/cm(2)). 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.

Pain experience in children with juvenile idiopathic arthritis treated with anti-TNF agents compared to non-biologic standard treatment.

BACKGROUND: Anti-TNF agents have proven efficacy in children with severe juvenile idiopathic arthritis (JIA) who are unresponsive to standard therapy. Therefore pain reduction or elimination could be expected. The aim of this study was to compare the pain experience in children with JIA treated with anti-TNF agents (n = 41) or non-biologic standard treatment (n = 50). METHODS: All children completed a 2-week pain diary and, for children treated with anti-TNF agents, measures of pain-coping and pain-specific beliefs. Parents rated the child's level of functional disability. Clinical data were collected from the pediatric rheumatologists. RESULTS: No significant differences were found between the anti-TNF group and non-biologic standard treatment group for average pain score, number of children with daily pain reported in the pain diary, or level of functional disability. Significantly more children in the anti-TNF group reported no pain at all. Children undergoing standard treatment had significantly higher disease activity. Significant differences were found between the high pain patients treated with anti-TNF agents and the rest of the anti-TNF group in regards to their pain-specific beliefs of disability and harm, and the pain-coping strategy of catastrophizing. CONCLUSION: These results indicate that a great proportion of children treated with anti-TNF agents respond well to the treatment in regards to disease activity and pain, but pain was still a problem for a subgroup of children though they were in remission with biological agents. More focus on pain management is needed.