Positive Schemas, Coping, and Quality of Life in Pediatric Recurrent Abdominal Pain.

Pediatric recurrent abdominal pain is commonly associated with negative impacts on quality of life (QOL). Positive schemas (core beliefs about the self with subthemes of self-efficacy, optimism, trust, success, and worthiness) are a resilience factor that has not yet been examined within a pediatric recurrent pain context. This cross-sectional study examined (a) associations between positive schemas, pain coping, and youth QOL, and (b) exploratory analyses to investigate whether specific positive schema subthemes predicted QOL outcomes in youth with recurrent abdominal pain. Participants were 98 youth with recurrent abdominal pain (i.e., pain related to a disorder of gut-brain interaction [DGBI] or organic cause) who completed measures on positive schemas, QOL, and pain coping. Age and diagnostic status were controlled for in analyses. Positive schemas were significantly positively correlated with emotional, social, school, and overall QOL, as well as with approach and problem-focused avoidant coping, and significantly negatively correlated with emotion-focused coping. Worthiness was the strongest and only significant predictor of youth social functioning. Positive schemas may be an important cognitive resilience factor to consider within interventions for pediatric recurrent pain.

Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety.

This pilot examines a self-distancing augmentation to exposure. Nine youth with anxiety (ages 11-17; 67% female) completed treatment. The study employed a brief (eight session) crossover ABA/BAB design. Exposure difficulty, engagement with exposure, and treatment acceptability were examined as primary outcome variables. Visual inspection of plots indicated that youth completed more difficult exposures during augmented exposure sessions [EXSD] than classic exposure sessions [EX] by therapist- and youth-report and that therapists reported higher youth engagement during EXSD than EX sessions. There were no significant differences between EXSD and EX on exposure difficulty or engagement by therapist- or youth-report. Treatment acceptability was high, although some youth reported that self-distancing was "awkward". Self-distancing may be associated with increased exposure engagement and willingness to complete more difficult exposures, which has been linked to treatment outcomes. Future research is needed to further demonstrate this link, and link self-distancing to outcomes directly.

Illuminating Associations between Parenting and Deleterious Neighborhood Characteristics via an Exhaustive Modeling Approach.

Objective: Our goal was to illuminate associations between specific characteristics of under-resourced neighborhoods (i.e., socioeconomic deprivation, danger) and specific aspects of parenting (e.g., parental praise, parental nurturance, harsh parenting, parental control). Background: Prior work has highlighted associations between level of neighborhood disadvantage and the parenting of its residents. However, this work has yet to clarify the specific characteristics of the neighborhood or the types of parenting involved. Method: Exhaustive modelling analyses were conducted in a sample of 1,030 families of twins (average age 8 years; 51% male, 49% female; the racial composition was 82% White, 10% Black, 1% Asian, 1% Indigenous, 6% multiracial) from the Twin Study of Behavioral and Emotional Development in Children. Neighborhood and parenting were assessed using multiple informants and assessment strategies (neighborhood informants, family informants, administrative data, videotaped parent-child interactions). Results: Neighborhood socioeconomic deprivation (i.e., limited institutional and economic structural resources) demonstrated small but consistent associations with positive parenting behaviors and maternal control, but not with negative parenting behaviors. Neighborhood danger (i.e., recorded crime, fear of crime, exposure to community violence), by contrast, demonstrated weaker associations with parenting that dissipated once we controlled for overlap with socioeconomic deprivation. Conclusion: Danger and socioeconomic deprivation do not function as interchangeable characteristics of under-resourced neighborhoods, at least in terms of their association with positive parenting. Future studies should identify the specific mechanisms through which neighborhood socioeconomic deprivation is associated with supportive parenting.

The role of parenting in the intergenerational transmission of executive functioning: A genetically informed approach.

Deficits in executive functioning both run in families and serve as a transdiagnostic risk factor for psychopathology. The present study employed twin modeling to examine parenting as an environmental pathway underlying the intergenerational transmission of executive functioning in an at-risk community sample of children and adolescents (N = 354 pairs, 167 monozygotic). Using structural equation modeling of multi-informant reports of parenting and a multi-method measure of child executive functioning, we found that better parent executive functioning related to less harsh, warmer parenting, which in turn related to better child executive functioning. Second, we assessed the etiology of executive functioning via the nuclear twin family model, finding large non-shared environmental effects (E = .69) and low-to-moderate heritability (A = .22). We did not find evidence of shared environmental effects or passive genotype-environment correlation. Third, a bivariate twin model revealed significant shared environmental overlap between both warm and harsh parenting and child executive functioning (which may indicate either passive genotype-environment correlation or environmental mediation), and non-shared environmental overlap between only harsh parenting and child executive functioning (indicating an effect of harsh parenting separable from genetic confounds). In summary, genetics contribute to the intergenerational transmission of executive functioning, with environmental mechanisms, including harsh parenting, also making unique contributions.

Exposure-Focused CBT Outperforms Relaxation-Based Control in an RCT of Treatment for Child and Adolescent Anxiety.

OBJECTIVE: The relative contribution of individual cognitive behavioral therapy (CBT) components to treatment outcomes for child anxiety disorders (CADs) is unclear. Recent meta-analyses suggest that exposure may be the primary active ingredient in CBT for CADs, and that relaxation may be relatively less effective. This brief report tests the hypothesis that exposure-focused CBT (EF-CBT) would outperform a relaxation-based active therapy control (Relaxation Mentorship Training; RMT) for the treatment of CADs. METHOD: Participants were 102 youth with CADs (mean age = 11.91, 26 males; 76.4% White, 14.7% Multiracial, 3.9% Black, 3.9% Asian, 0.9% other/do not wish to identify) as part of an ongoing neuroimaging randomized controlled trial. Participants were randomly assigned (ratio 2:1) to receive 12 sessions of EF-CBT (n = 70) or RMT (n = 32). Clinical improvement was measured at Week 12 (Clinical Global Impression - Improvement scale; CGI-I); treatment response was defined as receiving a rating of "very much" or "much improved" on the CGI-I. Anxiety severity was measured at Weeks 1, 6, 9, 12 (Pediatric Anxiety Rating Scale; PARS). Outcome measures were completed by an independent evaluator unaware of condition. RESULTS: EF-CBT exhibited 2.98 times higher odds of treatment completion than RMT; 13 treatment non-completers were included in analyses. Estimated treatment response rates were higher for EF-CBT (57.3%) than for RMT (19.2%). Longitudinal analyses indicated that EF-CBT was associated with faster and more pronounced anxiety reductions than RMT on the PARS (Hedges' g = .77). CONCLUSIONS: Results suggest that EF-CBT without relaxation is effective for CADs, and more effective than a relaxation-based intervention.

Parenting moderates the etiology of callous-unemotional traits in middle childhood.

BACKGROUND: Callous-unemotional (CU) traits are associated with chronic and escalating trajectories of antisocial behavior. Extant etiologic studies suggest that heritability estimates for CU traits vary substantially, while also pointing to an environmental association between parenting and CU traits. METHODS: We used twin modeling to estimate additive genetic (A), shared environmental (C), and nonshared environmental (E) influences on CU traits, measured with the Inventory of Callous-Unemotional Traits (ICU) and its subscales. Our sample included 600 twin pairs (age 6-11, 230 monozygotic) from neighborhoods with above-average levels of family poverty, a risk factor for antisocial behavior. We examined the extent to which correlations between parenting, measured via parent and child report on the Parental Environment Questionnaire, and CU traits reflected genetic versus environmental factors. Then, we tested whether parenting moderated the heritability of CU traits. RESULTS: In the context of lower-income neighborhoods, CU traits were moderately to highly heritable (A = 54%) with similar moderate-to-high nonshared environmental influences (E = 46%). Bivariate models revealed that associations between CU traits and warm parenting were genetic (rA = .22) and environmental (rE = .19) in origin, whereas associations between CU traits and harsh parenting were largely genetic in origin (rA = .70). The heritability of CU traits decreased with increasing parental warmth and decreasing harshness. CONCLUSIONS: Callous-unemotional traits are both genetic and environmental in origin during middle childhood, but genetic influences are moderated by parenting quality. Parenting may be an important target for interventions, particularly among youth with greater genetic risk.

The Measurement and Conceptualization of Coping Responses in Pediatric Chronic Pain Populations: A Scoping Review.

Background: Pediatric chronic pain is a prevalent condition that requires significant coping to encourage optimal functioning; however, relevant research is vast, heterogeneous, and difficult to interpret. To date, no attempt has been made to map and summarize the measurement and conceptualization of coping responses in the context of pediatric chronic pain. Objectives: A scoping review was conducted to map and summarize the participant characteristics, methodologies, theoretical frameworks, and measures used to assess coping responses in youth with chronic pain. The extent to which authors used definitions and examples of coping responses (conceptual clarity) as well as consistently used measures (measurement consistency) and their corresponding conceptualizations (conceptual consistency) relative to how they were intended to be used were assessed. Methods: Searches were conducted through MEDLINE (PubMed) and PsycINFO. Following title/abstract screening, full-text extractions were performed on 125 English-language publications on coping in youth with chronic pain. Results: Of the 125 studies, only 12.8% used a theoretical framework to explain the coping responses assessed, and even fewer (7.2%) used theory to guide measure selection. Conceptual clarity was rated "low/very low" (i.e., no definitions and/or examples) for 47.2% of studies. The majority of studies were conducted in the United States (67%) and a preponderance of White and female participants was sampled. The research primarily used quantitative methods (85%) and cross-sectional designs (67%). Parent- or self-report questionnaires were the most common methods for assessing coping (86%). Of the 95 studies that utilized one of the 14 questionnaires with known psychometric properties, 33.7 and 55.8% had one or more discrepancies for conceptual and measurement consistency, respectively. Conclusions: This review highlights the lack of clear descriptions and theoretical frameworks of coping responses for pediatric chronic pain. Inconsistencies in the measurement and conceptualization of coping responses limit research and clinical advancements. As a field, we need to strive toward using well-developed theory to create fewer, more well-established standardized measures with clearly defined coping responses. Opportunities for qualitative and observational research in more diverse patient populations should be considered for theory construction and measure validation. Clinical Trial Registration: https://osf.io/xvn2a/?view_only=eff04e0c0b9649be89d403b10e9ff082.

Health-related quality of life in youth with abdominal pain: An examination of optimism and pain self-efficacy.

OBJECTIVES: Abdominal pain adversely impacts children with functional gastrointestinal disorders (FGIDs) or organic gastrointestinal disorders (OGIDs); findings are inconsistent regarding diagnosis and health-related quality of life (HRQoL). This study utilizes a positive psychology framework to understand the experience of youth with abdominal pain (i.e., do positive psychological factors, such as optimism and pain self-efficacy, relate to higher HRQoL?). Consistent with a protective factor model of resilience, in which personal assets may serve as buffers between risk factors and negative outcomes, optimism and pain self-efficacy were examined as they relate to HRQoL in youth with abdominal pain. Specifically, exploratory moderational analyses examined a) if optimism and pain self-efficacy moderate the relation between pain and HRQoL, and b) whether diagnostic status moderated the relation between optimism/pain self-efficacy and HRQoL. METHODS: In a cross-sectional, observational study, youth (n = 98; Mage = 13, SD = 3) experiencing abdominal pain related to FGIDs or OGIDs and one of their parents participated. Measures included pain intensity, optimism, pain self-efficacy, and HRQoL. Analyses controlled for diagnosis, age, and gender. RESULTS: Higher pain and age related to lower HRQoL. Higher levels of optimism and pain self-efficacy associated with HRQoL beyond demographics. Optimism and pain self-efficacy did not moderate the relation between pain and HRQoL. Diagnostic status did not moderate the relation between optimism or pain self-efficacy and HRQoL. DISCUSSION: Our results suggest positive relations between positive psychological factors (optimism, pain self-efficacy) and HRQoL in youth with abdominal pain. Such factors could be further examined in intervention studies.

Neurocognitive abilities associated with antisocial behavior with and without callous-unemotional traits in a community sample.

OBJECTIVE: Antisocial behavior (aggression, rule breaking) is associated with lower intelligence and executive function deficits. Research has not clarified whether these associations differ with the presence of callous-unemotional (CU) traits, particularly within levels of antisocial behavior observed in the community. METHOD: We examined whether antisocial behavior and CU traits were differentially associated with intelligence and executive function metrics in 474 adolescent twins (Mean age = 14.18; SD = 2.20) sampled from birth records to represent youth in the community living in neighborhoods with above average levels of poverty. Intelligence was assessed using standardized scores from the Shipley-2. Executive function was assessed using Go/No-Go and Stop Signal tasks. RESULTS: Neither antisocial behavior, nor CU traits alone, were associated with cognitive functioning when accounting for demographic factors. However, antisocial behavior and CU traits interacted to predict reaction time variability. At low levels of CU traits, antisocial behavior was associated with higher reaction time variability (traditionally thought to reflect worse sustained attention). At high levels of CU traits, antisocial behavior was associated with lower reaction time variability (thought to reflect better sustained attention). CONCLUSION: Elevated antisocial behavior and CU traits may be characterized by a distinct neurocognitive profile compared to elevated antisocial behavior in isolation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19.

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.

An ecological approach to understanding the developing brain: Examples linking poverty, parenting, neighborhoods, and the brain.

We describe an ecological approach to understanding the developing brain, with a focus on the effects of poverty-related adversity on brain function. We articulate how combining multilevel ecological models from developmental science and developmental psychopathology with human neuroscience can inform our approach to understanding the developmental neuroscience of risk and resilience. To illustrate this approach, we focus on associations between poverty and brain function, the roles parents and neighborhoods play in this context, and the potential impact of developmental timing. We also describe the major challenges and needed advances in these areas of research to better understand how and why poverty-related adversity may impact the developing brain, including the need for: a population neuroscience approach with greater attention to sampling and representation, genetically informed and causal designs, advances in assessing context and brain function, caution in interpretation of effects, and a focus on resilience. Work in this area has major implications for policy and prevention, which are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Number sense biases children's area judgments.

Humans are thought to use the approximate number system (ANS) to make quick approximations based on quantity even before learning to count. However, there has long been controversy regarding the salience of number versus other stimulus dimensions throughout development, including a recent proposal that number sense is derived from a sense of general magnitude. Here, we used a regression approach to disentangle numerical acuity from sensitivity to total surface area in both 5-year-old children and adults. We found that both children and adults displayed higher acuity when making numerosity judgments than total surface area judgments. Adults were largely able to ignore irrelevant stimulus features when making numerosity or total area judgments. Children were more biased by numerosity when making total area judgments than by total area when making numerosity judgments. These results provide evidence that number is more salient than total surface area even before the start of formal education and are inconsistent with the Sense of Magnitude proposal.

Neighborhood poverty predicts altered neural and behavioral response inhibition.

Socioeconomic disadvantage during childhood is associated with a myriad of negative adult outcomes. One mechanism through which disadvantage undermines positive outcomes may be by disrupting the development of self-control. The goal of the present study was to examine pathways from three key indicators of socioeconomic disadvantage - low family income, low maternal education, and neighborhood poverty - to neural and behavioral measures of response inhibition. We utilized data from a representative cohort of 215 twins (ages 7-18 years, 70% male) oversampled for exposure to disadvantage, who participated in the Michigan Twins Neurogenetics Study (MTwiNS), a study within the Michigan State University Twin Registry (MSUTR). Our child-friendly Go/No-Go task activated the bilateral inferior frontal gyrus (IFG), and activation during this task predicted behavioral inhibition performance, extending prior work on adults to youth. Critically, we also found that neighborhood poverty, assessed via geocoding, but not family income or maternal education, was associated with IFG activation, a finding that we replicated in an independent sample of disadvantaged youth. Further, we found that neighborhood poverty predicted response inhibition performance via its effect on IFG activation. These results provide the first mechanistic evidence that disadvantaged contexts may undermine self-control via their effect on the brain. The broader neighborhood, beyond familial contexts, may be critically important for this association, suggesting that contexts beyond the home have profound effects on the developing brain and behaviors critical for future health, wealth, and wellbeing.

The Acuity and Manipulability of the ANS Have Separable Influences on Preschoolers' Symbolic Math Achievement.

The approximate number system (ANS) is widely considered to be a foundation for the acquisition of uniquely human symbolic numerical capabilities. However, the mechanism by which the ANS may support symbolic number representations and mathematical thought remains poorly understood. In the present study, we investigated two pathways by which the ANS may influence early math abilities: variability in the acuity of the ANS representations, and children's' ability to manipulate ANS representations. We assessed the relation between 4-year-old children's performance on a non-symbolic numerical comparison task, a non-symbolic approximate addition task, and a standardized symbolic math assessment. Our results indicate that ANS acuity and ANS manipulability each contribute unique variance to preschooler's early math achievement, and this result holds after controlling for both IQ and executive functions. These findings suggest that there are multiple routes by which the ANS influences math achievement. Therefore, interventions that target both the precision and manipulability of the ANS may prove to be more beneficial for improving symbolic math skills compared to interventions that target only one of these factors.

Cognitive Behavioral Therapy for Anxiety and Fear in Pediatric Pain Contexts.

Pain is a highly prevalent experience in pediatric medical populations, both in an acute form (e.g., iatrogenic pain from needle procedures) as well as in more chronic forms (e.g., as a result of arthritis, inflammatory bowel disease, or as a disease/disorder in and of itself). Guided by the biopsychosocial model, the overarching objective of this work is to examine cognitive behavioral treatment of anxiety in pain contexts. Specific aims are to (a) provide a brief overview of anxiety in youth with a high fear of needles and those experiencing chronic pain, (b) review the evidence base for cognitive behavioral therapy (CBT) for these populations, (c) outline considerations for implementing CBT-based approaches, and (d) provide two case examples which illustrate the application of CBT in these contexts. Brief concluding remarks include suggestions for future research such as improved screening and treatment of comorbid anxiety in the context of pain.

The impact of loads on standard diameter, small diameter and mini implants: a comparative laboratory study.

OBJECTIVES: While caution in the use of small-diameter (< or = 3.5 mm) implants has been advocated in view of an increased risk of fatigue fracture under clinical loading conditions, a variety of implant designs with diameters < 3 mm are currently offered in the market for reconstructions including fixed restorations. There is an absence of reported laboratory studies and randomized-controlled clinical trials to demonstrate clinical efficacy for implant designs with small diameters. This laboratory study aimed to provide comparative data on the mechanical performance of a number of narrow commercially marketed implants. MATERIALS AND METHODS: Implants of varying designs were investigated under a standardized test set-up similar to that recommended for standardized ISO laboratory testing. Implant assemblies were mounted in acrylic blocks supporting laboratory cast crowns and subjected to 30 degrees off-axis loading on an LRX Tensometer. Continuous output data were collected using Nexygen software. RESULTS: Load/displacement curves demonstrated good grouping of samples for each design with elastic deformation up to a point of failure approximating the maximum load value for each sample. The maximum loads for Straumann (control) implants were 989 N (+/-107 N) for the 4.1 mm RN design, and 619 N (+/-50 N) for the 3.3 mm RN implant (an implant known to have a risk of fracture in clinical use). Values for mini implants were recorded as 261 N (+/-31 N) for the HiTec 2.4 mm implant, 237 N (+/-37 N) for the Osteocare 2.8 mm mini and 147 N (+/-25 N) for the Osteocare mini design. Other implant designs were also tested. CONCLUSIONS: The diameters of the commercially available implants tested demonstrated a major impact on their ability to withstand load, with those below 3 mm diameter yielding results significantly below a value representing a risk of fracture in clinical practice. The results therefore advocate caution when considering the applicability of implants < or = 3 mm diameter. Standardized fatigue testing is recommended for all commercially available implants.