Analysing a family-centred preoperative intervention programme: a dismantling approach.

BACKGROUND: The goal of this project was to identify key effective components of ADVANCE, a family-centred preoperative intervention programme, through the use of a dismantling approach. ADVANCE was previously demonstrated to be more effective than parental presence and just as effective as midazolam in reducing children's preoperative anxiety. The total programme, however, may be difficult to implement in hospitals across the country. METHODS: Subjects in this follow-up dismantling report were 96 children aged 2-10 who were part of the original study and who underwent anaesthesia and surgery. Baseline characteristics, parental adherence to the components of ADVANCE, and child and parent anxiety were assessed. RESULTS: We found that greater parental adherence to the ADVANCE intervention was associated with lower child anxiety before surgery. The two components of ADVANCE that emerged as having a significant impact on children's anxiety were practising with the anaesthesia mask at home and parental planning and use of distraction in the preoperative holding area. In fact, not only did children experience significantly less preoperative anxiety when their parents were adherent to mask practise and use of distraction, their anxiety tended to remain stable and relatively low throughout the preoperative period. CONCLUSIONS: Shaping and exposure (i.e. practise with the anaesthesia mask) and parental use of distraction in the surgical setting are two beneficial components that could be included in preoperative preparation programmes that will be designed in the future.

Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations.

This study compared distraction, an anesthetic (eutectic mixture of local anesthetics [EMLA]), and typical care during pediatric immunizations. Participants were 39 4th graders receiving a 3-injection vaccination series over a 6-month period. Children displayed low distress despite reporting moderate anxiety and pain. Distraction resulted in more nurse coaching and child coping and less child distress than did EMLA or typical care on an observational measure. EMLA did not result in increased child coping or decreased distress. In fact, the nurse coached more, and trends suggested that children coped more with typical care than with EMLA. Whereas participant ratings and heart rate did not differ among conditions, all 3 conditions demonstrated improvements over time with these measures. Satisfaction ratings suggested that children preferred the treatments to typical care, whereas the nurse appreciated aspects of each of the conditions. Finally, distraction was more economical than EMLA.

Association of parental psychological and behavioral factors and children's syncope.

The authors examined the associations between parental variables and child syncope (fainting). Children ages 7 to 18 years undergoing tilt-table testing for neurocardiogenic syncope (NCS) at a pediatric cardiac center served as participants (N = 56). Results revealed that fathers' shortness of breath and overall psychological distress were significantly related to syncope frequency and emergency room (ER) visits for girls. Mothers' overall psychological distress, depressive symptoms, and shortness of breath were associated with boys' frequency of syncope and ER visits. Fathers' psychological factors were highly correlated with syncope for the children diagnosed negative for NCS. The frequency of children's syncope was higher in stepfamilies than in homes with both biological parents, and the correlations between children's syncope and the stepfathers' psychological symptoms were greater than for the children and their biological fathers in intact families. The role of parental psychological factors on child syncope is supported.

The Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF): validation of a rating scale for children's and adults' behaviors during painful medical procedures.

This study evaluated the concurrent and construct validity of the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF), a behavior rating scale of children's acute procedural distress and coping, and the coping promoting behaviors and distress promoting behaviors of their parents and the medical personnel who were present in the medical treatment room. Sixty preschool children undergoing immunizations at a county health department served as subjects. Videotapes of the procedures were scored using three observational measures in addition to the CAMPIS-SF. Also, parent, nurse, and child report measures of child distress, fear, pain, and cooperation were obtained. Results indicated that the validity of the CAMPIS-SF codes of Child Coping, Child Distress, Parent Coping Promoting, Parent Distress Promoting, Nurse Coping Promoting, and Nurse Distress Promoting behaviors was supported by multiple significant correlations with the other measures. The interrater reliability of the 5-point CAMPIS-SF scales was good to excellent. The results emphasize that the CAMPIS-SF scales can be used to monitor not only children's acute procedural distress, but also their coping and the various adults' behaviors that significantly influence children's distress. Further, because of the CAMPIS-SF's ease of use, it is likely that the study of the effects of the social environment on children's distress and coping will be facilitated.

Locus of control and achievement in child psychiatric inpatients.

The relationship between the Nowicki-Strickland Locus of Control Scale for Children (Nowicki & Strickland, 1973) and academic achievement was examined in a sample of 66 child psychiatric inpatients. Previous studies had suggested that this measure correlated with achievement in normal samples (Nowicki & Strickland, 1973) but not in populations of male juvenile offenders (Little & Kendall, 1978). The product-moment correlation between the Nowicki-Strickland Scale and the Peabody Individual Achievement Test was significant. However, when the effect of IQ was controlled for in a partial correlation, there was no significant correlation. Discussion focuses on the relationship between these results and other findings in the area of locus of control, intelligence, and achievement.

Teaching a six-year-old girl to swallow pills.

The present study used a modeling and shaping procedure to teach a 6-year-old girl to take pills. During one 45-min session, following instruction and modeling by the experimenter, the subject was presented candy hearts of increasing size, with reinforcers provided for successful swallowing. Maintenance and generalization of treatment effects were reported at home and at school.

Psychosocial adjustment and peer competence of siblings of children with Attention-Deficit/Hyperactivity Disorder.

Preliminary data examined the relationships between mothers, their sons with Attention-Deficit/Hyperactivity Disorder (ADHD), and younger siblings. We hypothesized that the conflict between the mother and the son with ADHD would also occur in the relationship between the child with ADHD and the younger sibling. Significant associations were found among ADHD behaviors, family conflict variables, conflict in the relationship between mother and child with ADHD, conflict in the relationship between mother and younger sibling, and conflict in the relationship between the child with ADHD and the younger sibling. Further, significant associations were found between behavior symptoms associated with ADHD and more problematic family relationships. Of particular interest was the finding of an unexpected inverse association between siblings' peer competence and mother-ADHD conflict; specifically, that conflict occurring at home from ADHD accounted for a greater percentage of the variance in peer competence as rated by teachers. Recommendations are made for future research with larger samples, alternative designs, older siblings, and fathers.

Making the system work. Training pediatric oncology patients to cope and their parents to coach them during BMA/LP procedures.

Three 4- to 7-year-old pediatric oncology patients were taught to engage in distraction prior to painful bone marrow aspirations and lumbar puncture procedures and to use party blowers as a breathing technique during the painful procedures. Parents were taught to coach their children to use these coping behaviors. Using a multiple baseline across subjects design, results indicated that all of the parents increased their rate of coaching. Each child responded with increased coping and decreased observable distress after the first treatment session. One child returned to baseline levels of coping and distress on the next two sessions. The other two children maintained their high rates of coping and low rates of observable distress during the remaining treatment and during the maintenance sessions. Parents' coaching of their children to use coping behaviors also remained high during maintenance sessions.

Using intermittent reinforcement to program maintenance of verbal/nonverbal correspondence.

We investigated the effects of an intermittent reinforcement procedure on maintenance of verbal/nonverbal correspondence with nutritious snack choices in a day-care setting. Nutritious snack choices were first established using correspondence training procedures in a multiple baseline across three children. Withdrawal of the procedures with one subject led to loss of appropriate responding, suggesting the need for a maintenance strategy. The intermittent reinforcement procedure was implemented in a multiple baseline across subjects. Nutritious snack choices were observed consistently during the intermittent reinforcement condition and the subsequent extinction condition.

Reducing severe diurnal bruxism in two profoundly retarded females.

Several diurnal audible teeth grinding (bruxism) was found to affect 21.5% of a profoundly retarded population. However, no previous research has treated bruxism in retarded individuals. In the current study a multiple baseline across subjects design was used to assess the effectiveness of contingent "icing," brief contingent tactile applications of ice, as a treatment for bruxism. Three 15-minute treatment periods and two 5-minute generalization periods were conducted 5 days per week. One resident displayed a 95% reduction in the percentage of intervals during which bruxism occurred during treatment periods and a 67% reduction during generalization periods. The other resident displayed a 94% reduction in the percentage of intervals during which bruxism occurred during treatment periods and a 53% reduction during generalization periods.

The dissemination of cost-effective psychosocial programs for children in health care settings.

Psychosocial programs for children must be both efficient and efficacious. Efficiency is dictated by cost, case of implementation, and likelihood of program compliance. Unfortunately, in attempting to promote efficient programs, inefficacious programs have been disseminated. Also, there are instances of failing to disseminate efficacious programs because they are not efficient. This paper presents a three-stage model as a guide for the dissemination of psychosocial programs. Further, specific suggestions are given as to how we may move from the level of efficacious treatments that are currently used on a limited scale to widespread dissemination.

The Behavioral Approach-Avoidance and Distress Scale: an investigation of reliability and validity during painful medical procedures.

Validated the use of the Behavioral Approach-Avoidance and Distress Scale (BAADS; Hubert, Jay, Saltoun, & Hayes, 1988), which was reported to be easily completed and scored in an analog situation, for measuring children's distress and coping style during actual painful medical procedures. 60 preschool children who were receiving immunizations at a health department were subjects. Objective measures (Observational Scale of Behavioral Distress and Child-Adult Medical Procedure Interaction Scale-Revised) and subjective measures (child-, parent-, and nurse-report) were used. Results of the current study support the internal consistency and concurrent validity of the Distress subscale of the BAADS; however, some caution is suggested in interpreting the Approach-Avoidance subscale. Discussion focuses on the utility of this scale in clinical settings and the cost-effectiveness of this measure for assessing pediatric patients.

A comparison of the OHI-S and the PHP in an oral hygiene program.

This study examined two critical measurement properties of the Simplified Oral Hygiene Index (OHI-S) and the Patient Hygiene Performance method (PHP). Both scales proved to be sufficiently sensitive to decreases in plaque.

Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations.

Evaluated a low cost and practical intervention designed to decrease children's, parents', and nurses' distress during children's immunizations. The intervention consisted of children viewing a popular cartoon movie and being coached by nurses and parents to attend to the movie. Ninety-two children, 4-6 years of age, and their parents were alternatively assigned to either a nurse coach intervention, a nurse coach plus train parent and child intervention, or a standard medical care condition. Based on previous findings of generalization of adult behaviors during medical procedures, it was hypothesized that training only the nurses to coach the children would cost-effectively reduce all participants levels of distress. Observational measures and subjective ratings were used to assess the following dependent variables: children's coping, distress, pain, and need for restraint; nurses' and parents' coaching behavior; and parents' and nurses' distress. Results indicate that, in the two intervention conditions, children coped more and were less distressed, nurses and parents exhibited more coping promoting behavior and less distress promoting behavior, and parents and nurses were less distressed than in the control condition. Although neither intervention was superior on any of the variables assessed in the study, nurse coach was markedly more practical and cost-effective. Therefore, nurses' coaching of children to watch cartoon movies has great potential for dissemination in pediatric settings.