Revisiting the accuracy hypothesis in families of young children with conduct problems.

Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.

A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery.

Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9-12 months) and patients undergoing surgery at approximately 1.5 years of age (15-18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.

Efficacy of parent-child interaction therapy: interim report of a randomized trial with short-term maintenance.

Describes interim results of a study examining the effectiveness of parent-child interaction therapy (PCIT) with families of preschool-age children with oppositional defiant disorder. Following an initial assessment, 64 clinic-referred families were randomly assigned to an immediate treatment (i.t.) or a wait-list control (WL) condition. Results indicated that parents in the IT condition interacted more positively with their child and were more successful in gaining their child's compliance than parents in the WL condition. In addition, parents who received treatment reported decreased parenting stress and a more internal locus of control. Parents in the IT group reported statistically and clinically significant improvements in their child's behavior following PCIT. All families who received treatment reported high levels of satisfaction with both the content and process of PCIT. Preliminary 4-month follow-up data showed that parents maintained gains on all self-report measures.

Stage II breast cancer: differences between four coping patterns in side effects during adjuvant chemotherapy.

Fifty-six women with stage II breast cancer receiving adjuvant chemotherapy were recruited for a study evaluating and comparing coping patterns for differences in physical and psychological side effects during treatment with adjuvant chemotherapy. Cluster analyses were used to split women into confrontive, avoidant-confrontive, avoidant-resigned, and resigned coping clusters. Side-effect measurements were taken on the day of adjuvant chemotherapy infusion and 3 and 7 days later. Repeated measures ANCOVAs indicated that coping clusters predicted significant variance in physical, psychological, and total side effects when variance in covariates was held constant. Confrontive subjects reported significantly fewer psychological and physical symptoms than avoidant-confrontive and avoidant-resigned copers. Confrontive copers also reported fewer side effects than resigned copers, but this difference was not significant when differences in covariate distributions were controlled. Particularly robust differences were noted when confrontive copers were compared with avoidant-confrontive copers. Results suggest that a critical component in optimal coping may be a willingness to discuss and think about illness.

Parent-child interaction therapy: a psychosocial model for the treatment of young children with conduct problem behavior and their families.

This article describes a treatment project designed to examine the effectiveness and generalization of Parent-Child Interaction Therapy (PCIT) with families of preschool-aged children with conduct problem behavior. The importance of early intervention and issues related to measurement of change in these young children and their families are discussed. The treatment program and the study design are described, with particular emphasis on the measures used to assess treatment outcome. The sensitivity of the measures to change is illustrated with data from the first few families who have completed treatment.

Behavioral upset in medical patients--revised: evaluation of a parent report measure of distress for pediatric populations.

Examined the utility of a new parent-report measure designed specifically for pediatric inpatients, the Behavioral Upset in Medical Patients-Revised (BUMP-R). The BUMP-R was administered to 151 mothers of hospitalized children ages 4-12 years the day following the child's hospital admission. The BUMP-R demonstrated good internal consistency and a factor analysis revealed four factors identified as negativity/agitation, amiability, dysphoria, and noncompliance. Children exhibiting behavioral distress at home were more likely to experience adjustment problems upon hospitalization. Demographic and illness-related variables were not substantial risk factors for hospital adjustment difficulties.

Cluster analysis of the medical coping modes questionnaire: evidence for coping with cancer styles?

A number of researchers have attempted to understand how individuals cope with having cancer. Unfortunately, this voluminous literature has suffered from a number of problems common to other pre-paridigmic disciples. Studies are generally isolated and fail to build upon other research in the literature. In addition, no guiding theory or conceptualization exists that helps to explain and describe the richness and complexity of observed clinical phenomena. With the understanding that coping with cancer is multidimensional, some researchers have attempted to group coping responses into dominant styles. In an effort to better understand the results of this approach, we performed a cluster analysis on 117 responses to a three scale questionnaire, the Medical Coping Modes Questionnaire. Results indicated that subjects can be grouped into one of four coping categories: confrontive, avoidant, resigned, or with a nondominant style. Future research is needed to explore how these styles influence quality of life during and following treatment.

Current status of psychological research in organ transplantation.

Research addressing the psychological concomitants of organ transplantation is reviewed. Specifically, cognitive, behavioral, and psychosocial correlates of kidney, heart, liver, and bone marrow transplantation in both children and adults are discussed. Despite several conceptual and methodological shortcomings of the psychologically-based research in this area, results seem to indicate that organ transplantation is associated with many psychological issues at pretransplantation, posttransplantation, and follow-up periods. Implications of these general findings for the advancing roles of the health psychologist in organ transplantation are discussed.

Social support, family variables, and compliance in renal transplant children.

The relationship between family functioning, social support, and medication compliance in 32 renal transplant children and their parents was examined. Results indicated that children whose fathers gave more emotional support or were more informative were less compliant with azathioprine and cyclosporine (P < 0.05 for both). Children from families experiencing numerous stresses were also found to be less compliant with azathioprine (P < 0.05). Finally, compared with older children, younger children were found to be less compliant with cyclosporine (P < 0.005). Implications for predicting child adherence and for future research relating to compliance with multidrug regimens are discussed.

Mood, coping style, and personality functioning among adult bone marrow transplant candidates.

Increasing use of bone marrow transplantation (BMT) and improved survival rates have led to growing concerns regarding the psychological adjustment of BMT recipients. However, few systematic studies have been conducted and those reported have focused primarily on the psychological functioning of BMT recipients several months or years after transplantation. In this article, the authors report normative psychological data on 51 BMT candidates assessed before hospitalization. Overall, the authors found little support for previous anecdotal reports that hypothesized increased incidences of negative affect during this preadmission period. Interestingly, however, patients' use of a passive coping style was significantly correlated with higher degrees of negative affect and psychopathology. The data reported provide a foundation for a more prospective, longitudinal assessment of BMT patients.

Behavioral treatment of nocturnal enuresis in children with insulin-dependent diabetes mellitus.

Examined whether a well-established treatment program for functional enuresis, the urine alarm procedure, would be useful for children with both enuresis and diabetes. 5 children between the ages of 7 and 14 whose pretreatment physical examination suggested no neurological impairment were treated. A multiple baseline design across children indicated that the urine alarm procedure was successful in stopping enuretic episodes for all 5 children with treatment gains maintained for the 4 children available for assessment at 2-month follow-up. These results suggest that if no diabetes-related organic impairment is evident, behavioral treatment for enuresis can be beneficial for children with diabetes.

The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: an analogue study.

Evaluated the effect of varied physician affect on subject recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. Forty women at risk for breast cancer viewed videotapes of an oncologist presenting--with either worried or nonworried affect--mammogram results. Although the mammogram results and the oncologist were the same in both presentation, analyses indicated that, compared to the women receiving the results from a nonworried physician, the women receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. These results suggest that physician affect plays a critical role in patient reaction to medical information. Implications for compliance research, patient satisfaction, and physician training are discussed.