Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis.

INTRODUCTION: In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. METHODS: We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire - Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. RESULTS: Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: -0.63; 95% CI: -0.99 to -0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: -0.74; 95% CI: -1.24 to -0.25). DISCUSSION: Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.

Preparation for Adulthood: Shifting Responsibility for Management of Daily Tasks From Parents to Their Children.

IMPORTANCE: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood. OBJECTIVE: To describe the timing of the shift of responsibility for daily tasks from parent to child. DESIGN: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests. PARTICIPANTS: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr. OUTCOMES AND MEASURES: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task). RESULTS: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15. CONCLUSIONS AND RELEVANCE: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood. WHAT THIS ARTICLE ADDS: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult.

Variables Associated With Shift of Responsibility for Daily Tasks From Parents to Children With and Without Disabilities.

IMPORTANCE: No study has directly investigated which variables are associated with the shift of responsibility for managing daily tasks from parent to child in the transition to adulthood. OBJECTIVE: To examine characteristics associated with responsibility for managing daily life tasks in youth with and without disabilities. DESIGN: A secondary data analysis of parent-report data on typically developing (TD) youth and youth with disabilities. SETTING: An online panel that has regularly participated in online surveys. PARTICIPANTS: A nationally representative sample of 2,205 TD U.S. children and youth, ages 0 to 20 yr, 11 mo (about 100 children per age year) and a sample of 617 children and youth with disabilities, ages 0 to 20 yr, 11 mo. OUTCOMES AND MEASURES: The dependent variable was the Responsibility domain scaled score (from the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test), which reflects the extent to which responsibility for daily tasks has shifted from parent to youth. RESULTS: Youth with higher levels of responsibility were older in age, reported to be more focused, and youngest in birth order (TD, R 2 = .79; disability, R 2 = .35). Youth with developmental delay, intellectual disability, autism spectrum disorder, or orthopedic or movement impairments had assumed less responsibility. CONCLUSIONS AND RELEVANCE: Other personal characteristics in addition to disability may have important influences on parents' decision making as they prepare their children to manage daily life tasks. WHAT THIS ARTICLE ADDS: Clinicians who work with adolescents in the process of transition to adulthood need to consider the potential influence of the personal characteristics, such as birth order and child temperament, on preparation for adulthood.

Evaluating the appropriateness of a new computer-administered measure of adaptive function for children and youth with autism spectrum disorders.

The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test is an alternative method for describing the adaptive function of children and youth with disabilities using a computer-administered assessment. This study evaluated the performance of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test with a national sample of children and youth with autism spectrum disorders aged 3-21 years. Parents (n = 365) completed an online survey that included demographics, the Social Communication Questionnaire, and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test Social/Cognitive, Daily Activities, and Responsibility domains. Item response theory analysis confirmed items in each domain fit a unidimensional model and few items misfit. A large number of items in the Social/Cognitive domain showed differential item functioning, indicating a unique order of item difficulty in this population in this domain. Differences in item difficulty estimates were addressed through a parameter linking (equating) process. Simulations supported the accuracy and precision of the Computer Adaptive Test. Results suggest that the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test, as modified for autism spectrum disorder, is an efficient and sound assessment for this population.

Association between impairment, function, and daily life task management in children and adolescents with autism.

AIM: This cross-sectional study examined whether impairments or functional skills are associated with the level of responsibility for life tasks for children and adolescents with autism spectrum disorders (ASDs). METHOD: Parents of 263 children and adolescents with ASDs (215 males; 48 females; mean age 12y 6mo [SD 4y 6mo], range 3-21y) completed an online survey that included the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test - Autism Spectrum Disorders (PEDI-CAT-ASD) Daily Activities, Social/Cognitive, and Responsibility domains, a demographic questionnaire, and the Social Communication Questionnaire (SCQ) Current. The International Classification of Functioning, Disability and Health Framework guided the selection of model variables. We used hierarchical multiple regression to examine the relationship between impairment and functional skill predictor variables and the outcome variable, Responsibility. Age was entered in step 1 to control for the impact of development. SCQ Current, IQ, and remaining PEDI-CAT-ASD domains were then entered in step 2. RESULTS: After controlling for age, the model showed that step 2 predictor variables representing both impairments and functional skill improved the model (p<0.001). All variables except the SCQ score were significant predictors of Responsibility. The variance explained by the Daily Activities (2.7%) and Social/Cognitive (4.8%) domain scores was greater than IQ (0.3%). INTERPRETATION: The functional skills of Daily Activities and Social/Cognitive domains were more strongly associated with the management of life tasks than impairments after controlling for age.

Strategies to address participant misrepresentation for eligibility in Web-based research.

Emerging methodological research suggests that the World Wide Web ("Web") is an appropriate venue for survey data collection, and a promising area for delivering behavioral intervention. However, the use of the Web for research raises concerns regarding sample validity, particularly when the Web is used for recruitment and enrollment. The purpose of this paper is to describe the challenges experienced in two different Web-based studies in which participant misrepresentation threatened sample validity: a survey study and an online intervention study. The lessons learned from these experiences generated three types of strategies researchers can use to reduce the likelihood of participant misrepresentation for eligibility in Web-based research. Examples of procedural/design strategies, technical/software strategies and data analytic strategies are provided along with the methodological strengths and limitations of specific strategies. The discussion includes a series of considerations to guide researchers in the selection of strategies that may be most appropriate given the aims, resources and target population of their studies.

Community participation, supports, and barriers of school-age children with and without disabilities.

OBJECTIVE: To examine patterns of community participation and environmental factors that affect community participation for school-age children with and without disabilities. DESIGN: Cross-sectional, descriptive, and exploratory study. SETTING: Parents from the United States and Canada completed the main outcome measure online in their homes or communities. PARTICIPANTS: Parents (N=576) reported on their children aged 5 to 17 years with disabilities (n=282) and without disabilities (n=294). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participation and Environment Measure for Children and Youth. RESULTS: Group differences in summary scores and many items were significant (P<.001). Children with disabilities participated less frequently, were less involved, and had less environmental support in the community than children without disabilities. Parents of children with disabilities desired more change in their child's participation than parents of children without disabilities. Effect sizes for summary scores were moderate to very large (n(2)p from .11-.40), with the largest group difference found in environment scores. Overall, the largest group differences in participation were in "unstructured physical activities" and "getting together with other children"-also the 2 areas where parents of children with disabilities most frequently desired change. The largest differences in environmental impact were in physical, social, and cognitive activity demands and availability/adequacy of programs and services. CONCLUSIONS: Results provide insights about where greater efforts are needed to support community participation of school-age children with disabilities. Further study with a more diverse sample in terms of race/ethnicity, family income/education levels, and geographic region is needed to determine the extent to which results may be generalized.

Comparing the functional performance of children and youths with autism, developmental disabilities, and no disability using the revised pediatric evaluation of disability inventory item banks.

OBJECTIVE. We compared the functional performance of children with autism spectrum disorders (ASD), intellectual and developmental disabilities (IDD), and without disabilities using the revised Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) Social/Cognitive, Daily Activities, and Responsibility domains. METHOD. A nationally representative sample of parents of children ages 0-21 without disabilities (n = 2,205), with ASD (n = 108), or with IDD (n = 150) completed an online survey. We obtained predicted PEDI-CAT scaled scores for three reference ages (5, 10, 15) from a modified analysis of covariance model and compared each group's scores using contrasts of the regression parameters. RESULTS. We found no significant differences between the ASD and IDD groups. The group with ASD demonstrated significantly lower performance than the group without disabilities across the three domains at ages 10 and 15. CONCLUSION. Scores on the PEDI-CAT differentiated the group with ASD from the group without disabilities. Children with ASD and IDD did not demonstrate different performance profiles.

Computer adaptive test performance in children with and without disabilities: prospective field study of the PEDI-CAT.

PURPOSE: To examine the discriminant validity, test-retest reliability, administration time and acceptability of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT). METHODS: A sample of 102 parents of children 3 through 20 years of age with (n = 50) and without (n = 52) disabilities was recruited for this prospective field study. A sub-sample (n = 25) also completed the PEDI-CAT a second time within one month. Parents completed 15 items in each of the four PEDI-CAT domains (daily activities, mobility, social/cognitive, responsibility) using a laptop computer. Following completion, parents answered a four-question user evaluation survey. RESULTS: PEDI-CAT scores based on parent responses differentiated between groups of children with and without disabilities in all four domains. Test-retest reliability estimates were high (ICC = 0.96-0.99) for all four domains. The mean time to complete 60 items for the full sample (n = 102) was 12.66 minutes (SD = 4.47). Parents reported favorable reactions to the PEDI-CAT. CONCLUSIONS: The PEDI-CAT offers a valid and reliable assessment acceptable to parents.

A new approach to the measurement of adaptive behavior: development of the PEDI-CAT for children and youth with autism spectrum disorders.

The use of current adaptive behavior measures in practice and research is limited by their length and need for a professional interviewer. There is a need for alternative measures that more efficiently assess adaptive behavior in children and youth with autism spectrum disorders (ASDs). The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) is a computer-based assessment of a child's ability to perform activities required for personal self-sufficiency and engagement in the community. This study evaluated the applicability, representativeness, and comprehensiveness of the Daily Activity, Social/Cognitive, and Responsibility domains for children and youth with an ASD. Twenty professionals and 18 parents provided feedback via in-person or virtual focus groups and cognitive interviews. Items were perceived to represent relevant functional activities within each domain. Child factors and assessment characteristics influenced parents' ratings. In response to feedback, 15 items and additional directions were added to ensure the PEDI-CAT is a meaningful measure when used with this population.

Accuracy and precision of the Pediatric Evaluation of Disability Inventory computer-adaptive tests (PEDI-CAT).

AIM: The aims of the study were to: (1) build new item banks for a revised version of the Pediatric Evaluation of Disability Inventory (PEDI) with four content domains: daily activities, mobility, social/cognitive, and responsibility; and (2) use post-hoc simulations based on the combined normative and disability calibration samples to assess the accuracy and precision of the PEDI computer-adaptive tests (PEDI-CAT) compared with the administration of all items. METHOD: Parents of typically developing children (n = 2205) and parents of children and adolescents with disabilities (n = 703) between the ages of 0 and 21 years, stratified by age and sex, participated by responding to PEDI-CAT surveys through an existing Internet opt-in survey panel in the USA and by computer tablets in clinical sites. RESULTS: Confirmatory factor analyses supported four unidimensional content domains. Scores using the real data post hoc demonstrated excellent accuracy (intraclass correlation coefficients ≥ 0.95) with the full item banks. Simulations using item parameter estimates demonstrated relatively small bias in the 10-item and 15-item CAT versions; error was generally higher at the scale extremes. INTERPRETATION: These results suggest the PEDI-CAT can be an accurate and precise assessment of children's daily performance at all functional levels.

Psychometric evaluation of the Participation and Environment Measure for Children and Youth.

AIM: The aim of this study was to examine the psychometric properties (reliability and validity) of the Participation and Environment Measure for Children and Youth (PEM-CY). METHOD: The PEM-CY examines participation frequency, extent of involvement, and desire for change in sets of activities typical for the home, school, or community. Items in the 'Environment' section examine perceived supports and barriers to participation within each setting. Data were collected via an online survey from caregivers of children and young people, aged 5 to 17 years, with and without a range of different disabilities, residing in the USA and Canada. Caregivers were eligible for inclusion if (1) they identified themselves as a parent or legal guardian of the child who was the focus of the survey; (2) they were able to read English; and (3) their child was between 5 and 17 years old at the time of enrolment. RESULTS: Data were obtained from 576 respondents. About half were parents of children with disabilities and a little more than half were from Canada. Child mean age was 11 years (SD 3.1y); 54% were male and 46% were female. Internal consistency was moderate to good (0.59 and above) across the different scales. Test-retest reliability was moderate to good (0.58 and above) across a 1- to 4-week period. There were large and significant differences between the groups with and without disabilities on all participation and environment scales. Although there were some significant age differences, they did not follow a consistent pattern. INTERPRETATION: Results support the use of the PEM-CY for population-level studies to gain a better understanding of the participation of children and young people and the impact of environmental factors on their participation.

Item bank development for a revised pediatric evaluation of disability inventory (PEDI).

The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options were reviewed by clinician experts and examined at parent and clinician focus groups. Eleven parents participated in 32 cognitive interviews to examine content, format, and comprehension of items and responses. A set of 76 self-care, 78 mobility, and 64 social function items with pictures and a four-point "Difficulty" scale were developed. The PEDI's Caregiver Assistance scale was replaced by a "Responsibility Scale" with 53 items. Content validity was established incorporating input from clinicians and parents. The new item bank covers a broad range of functional activities for children of all ages and abilities.

Lessons from use of the Pediatric Evaluation of Disability Inventory: where do we go from here?

PURPOSE: The purpose of this article is to review the innovations, applications, and effect of the original Pediatric Evaluation of Disability Inventory (PEDI) published in 1992 and to describe planned revisions. SUMMARY OF KEY POINTS: During the past decade, the PEDI has helped to shift thinking from a developmental to a functional focus. Using the PEDI, researchers and clinicians worldwide have highlighted variations in functional skill acquisition in clinical populations, the importance of recognizing cultural differences, and the value of documenting functional progress in relation to interventions. CONCLUSIONS: The PEDI has had a rich tradition in helping to document functional development. New methods are proposed for the next generation of the PEDI by using item banks and computer adaptive testing. RECOMMENDATIONS FOR CLINICAL PRACTICE: The computer adaptive testing feature and the revised and expanded content of the new PEDI will enable therapists to more efficiently assess children's functioning to a broader age group of children.