Testing a model of benefit-finding and growth in youths with chronic health conditions.

BACKGROUND: The experience of benefit-finding and growth (BFG), defined as perceiving positive life changes resulting from adversity, is increasingly studied among youths with chronic health conditions (CCs). However, empirical evidence is scarce for explaining individual differences in BFG. The study aimed to test a model of BFG, including an interplay of personal and environmental factors and coping processes. METHODS: A sample of N = 498 youths (12-21 years) recruited from three German patient registries for CCs (type 1 diabetes: n = 388, juvenile idiopathic arthritis: n = 82, cystic fibrosis: n = 28) completed a questionnaire including self-reported optimism, social support from parents and peers, coping strategies, and BFG. The model was created to reflect the theoretical assumptions of the Life Crisis and Personal Growth model and current empirical evidence. Structural equation modeling was conducted to evaluate the incremental explanatory power of optimism, peer group integration, parental support, acceptance, cognitive reappraisal, and seeking social support over and above sociodemographic and disease-related characteristics. RESULTS: The model (CFI = 0.93; RMSEA = 0.04; SRMR = 0.05) explained 32% of the variance in BFG. Controlling for sociodemographic and disease-related characteristics, acceptance, cognitive reappraisal, and seeking social support were directly and positively linked to BFG. All tested coping strategies significantly mediated the association between optimism and BFG, whereas seeking social support significantly mediated the relation between peer group integration and BFG. DISCUSSION: The study stresses the prominent role of emotion-focused coping strategies and peer group integration in enhancing BFG in youths with CCs. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00025125. Registered on May 17, 2021.

Motivational interviewing from the paediatricians' perspective: assessments after a 2-day training for physicians caring for adolescents with chronic medical conditions (CMCs).

BACKGROUND: Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians' attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility and implementation of MI sessions in everyday practice are missing from the physicians' point of view. METHOD: The present study was conducted as a mixed methods design. Twenty paediatricians were randomized to a 2-day MI course followed by MI consultations. Data were collected through a questionnaire one year after MI training. Factors for effective training and possible barriers to successful use of MI were examined. RESULTS: Completed questionnaires were returned by 19 of 20 paediatricians. The paediatricians' experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95% of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7% percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow. CONCLUSIONS: MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and provided a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS00014043) on 26/04/2018.

Originalarbeiten / Original Articles. Die protektive Rolle von Selbstregulation für die gesundheitsbezogene Lebensqualität bei Jugendlichen mit einer chronisch körperlichen Erkrankung / The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition.

The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition A physical chronic condition comes with many challenges and negatively impacts the healthrelated quality of life (HRQOL) of those affected. Self-regulation plays an important role in successfully coping with the demands of a chronic condition. In line with a resource-oriented approach, this study aimed to investigate themoderating effect of self-regulation on the relationship between disease severity andHRQOL. For this, 498 adolescents with cystic fibrosis, juvenile idiopathic arthritis, or type-1 diabetes aged of 12-21 years (M= 15.43, SD= 2.07) were recruited through three patient registers. Subjective disease severity, self-regulation (Brief Self-Control- Scale), andHRQOL (DISABKIDSChronicGenericMeasure)were examined at two time points (T1 and T2, one year apart). Cross-sectional analysis showed significant effects of subjective disease severity and self-regulation on HRQOL. Prospective analysis, in which HRQOL at T1 was controlled for, revealed that disease severity only predicted emotion-related HRQOL at T2; selfregulation emerged as a predictor for HRQOL subscales independence, emotion, inclusion, exclusion, and treatment. A significantmoderation effect of self-regulation was found on the relationship between disease severity and HRQOL emotion. Our results highlight the positive impact of self-regulation on quality of life, specifically in the context of chronic conditions and represent a starting point for prevention and intervention approaches.

Originalarbeiten / Original Articles. Die Bedeutung von Selbstregulation in der Entwicklung internalisierender Symptome während der mittleren Kindheit / The Importance of Self-Regulation in the Development of Internalizing Symptoms During Middle Childhood.

The Importance of Self-Regulation in the Development of Internalizing Symptoms During Middle Childhood Current research discusses low self-regulation abilities during childhood as risk factors for the development of internalizing symptoms. However, longitudinal studies investigatingmultiple self-regulation facets simultaneously are scarce. We examined whether impairments in various self-regulation facets (emotional reactivity, inhibition, inhibitory control, planning behavior) in middle childhood predict internalizing symptoms two years later and whether they make an incremental contribution when established risk factors (gender, family adversity) are considered. Furthermore, we investigated whether self-regulation facets predict later internalizing symptoms under consideration of internalizing symptoms at baseline.The sample consisted of 1,617 children (t1:Mage = 9.1, t2:Mage = 11.1 years), assessed at two measurement points. Internalizing symptoms were rated by parents on the Emotional Problems Scale of the Strengths and Difficulties Questionnaire. Self-regulation facets were measured at the first measurement point using various methods and informants. A stepwise regression analysis revealed that increased emotional reactivity, reduced inhibitory control, and reduced planning behavior significantly predicted later internalizing symptoms, explaining 14.8 % of the variance. Adding risk factors increased the explained variance by 2.5 %. Under consideration of baseline internalizing symptoms, reduced inhibition and inhibitory control significantly predicted later internalizing symptoms, while other self-regulation facets and risk factors did not. Results of this study may inform prevention and intervention measures.

A prospective analysis of the long-term impact of the COVID-19 pandemic on well-being and health care among children with a chronic condition and their families: a study protocol of the KICK-COVID study.

BACKGROUND: There is consistent evidence that the COVID-19 pandemic is associated with an increased psychosocial burden on children and adolescents and their parents. Relatively little is known about its particular impact on high-risk groups with chronic physical health conditions (CCs). Therefore, the primary aim of the study is to analyze the multiple impacts on health care and psychosocial well-being on these children and adolescents and their parents. METHODS: We will implement a two-stage approach. In the first step, parents and their underage children from three German patient registries for diabetes, obesity, and rheumatic diseases, are invited to fill out short questionnaires including questions about corona-specific stressors, the health care situation, and psychosocial well-being. In the next step, a more comprehensive, in-depth online survey is carried out in a smaller subsample. DISCUSSION: The study will provide insights into the multiple longer-term stressors during the COVID-19 pandemic in families with a child with a CC. The simultaneous consideration of medical and psycho-social endpoints will help to gain a deeper understanding of the complex interactions affecting family functioning, psychological well-being, and health care delivery. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00027974. Registered on 27th of January 2022.

Interrelation between weight and weight stigma in youth: is there evidence for an obesogenic vicious cycle?

Many children and adolescents are confronted with weight stigma, which can cause psychological and physical burden. While theoretical frameworks postulate a vicious cycle linking stigma and weight status, there is a lack of empirical evidence. The aim was to analyze the longitudinal bidirectional relationship between body weight and weight stigma among children and adolescents. The sample consisted of 1381 children and adolescents, aged 9-19 years at baseline (49.2% female; 78% normal weight), from a prospective study encompassing three measurement points over 6 years. Participants provided self-reported data on experienced weight-related teasing and weight/height (as indicators for weight status). Latent structural equation modelling was used to examine the relationship between weight-related teasing experiences and weight. Additionally, gender-related differences were analyzed. Between the first two waves, there was evidence for a bidirectional relationship between weight and weight-related teasing. Between the last two waves, teasing predicted weight, but there was no reverse association. No gender-related differences were found. The data indicate a reciprocal association between weight stigma and body weight across weight groups and independent of gender. To prevent vicious cycles, approaches that simultaneously promote healthy weight and reduce weight stigma are required.

Treatment for Pediatric Functional Abdominal Pain: An Initial Examination of Reciprocal Associations Between Pain, Functional Impairment, and Parental Distress.

OBJECTIVE: While cross-sectional studies underline that child and parent factors in pediatric chronic pain are reciprocally related, so far, little is known on their prospective relationship, especially in treatment contexts. This study aims to analyze directions of influence between child and parental outcomes using data from an intervention study. METHODS: The sample covered 109 families with children aged 7-13 years diagnosed with functional abdominal pain (FAP). Child outcomes included pain and impairment, and parental outcomes covered caregiver-specific distress including both parental personal time burden (i.e., less time available for personal needs) and emotional burden due to child's pain (i.e., increased worries). Cross-lagged panel analyses examined the directions of the relations between child and parental outcomes across time (pretreatment T1, post-treatment T2, and 3-month follow-up and 12-month follow-up T3/T4). RESULTS: First, a significant improvement over time in all measures was observed. Cross-lagged effects were found for less parental personal time burden at T2, predicting both less pain (ß = -0.254, p = .004) and less impairment (ß = -0.150, p = .039) at T3. Higher baseline pain was predictive for higher parental emotional burden after treatment (ß = -0.130, p = .049) and, reversely, for less emotional burden at 12-month follow-up (ß = 0.261, p = .004). CONCLUSIONS: Addressing parental personal time burden in FAP treatment might possibly support the improvement on the child level. Replication of results in larger samples is warranted to gain more insight into the directions of influence and, in that way, to optimize treatment for pediatric FAP.

An experimental approach to training interoceptive sensitivity: study protocol for a pilot randomized controlled trial.

BACKGROUND: Eating in absence of hunger is quite common and often associated with an increased energy intake co-existent with a poorer food choice. Intuitive eating (IE), i.e., eating in accordance with internal hunger and satiety cues, may protect from overeating. IE, however, requires accurate perception and processing of one's own bodily signals, also referred to as interoceptive sensitivity. Training interoceptive sensitivity might therefore be an effective method to promote IE and prevent overeating. As most studies on eating behavior are conducted in younger adults and close social relationships influence health-related behavior, this study focuses on middle-aged and older couples. METHODS: The present pilot randomized intervention study aims at investigating the feasibility and effectiveness of a 21-day mindfulness-based training program designed to increase interoceptive sensitivity. A total of N = 60 couples participating in the NutriAct Family Study, aged 50-80 years, will be recruited. This randomized-controlled intervention study comprises three measurement points (pre-intervention, post-intervention, 4-week follow-up) and a 21-day training that consists of daily mindfulness-based guided audio exercises (e.g., body scan). A three-arm intervention study design is applied to compare two intervention groups (training together as a couple vs. training alone) with a control group (no training). Each measurement point includes the assessment of self-reported and objective indicators of interoceptive sensitivity (primary outcome), self-reported indicators of intuitive and maladaptive eating (secondary outcomes), and additional variables. A training evaluation applying focus group discussions will be conducted to assess participants' overall acceptance of the training and its feasibility. DISCUSSION: By investigating the feasibility and effectiveness of a mindfulness-based training program to increase interoceptive sensitivity, the present study will contribute to a deeper understanding of how to promote healthy eating in older age. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00024903. Retrospectively registered on April 21, 2021.

Taking a closer look at mindful eating: incremental validity and importance of subfacets.

PURPOSE: Mindful eating (ME) seems a promising approach to clarify the underlying mechanisms of mindfulness-based interventions for eating and weight-related issues. The current study aimed to investigate the incremental validity of this eating-specific approach beyond a generic conception of mindfulness and explore preliminary indication which subfacets of the multidimensional construct ME might be of particular importance in order to study them more precisely and tailor mindfulness-based interventions for eating and weight-related issues more properly. METHODS: Self-report data (N = 292) were collected online. Hierarchical regression analyses were used to explore the incremental validity of ME beyond generic mindfulness, predicting maladaptive eating (emotional and uncontrolled eating) and consumption of energy-dense food. Multiple regressions were used to examine the impact of the seven different ME subfacets on the very same outcomes. RESULTS: Findings demonstrated the incremental validity of ME on all outcomes. Generic mindfulness no longer predicted emotional eating, uncontrolled eating, or the consumption of energy-dense food when entering ME. The subfacet 'non-reactive stance' predicted all three outcomes significantly. For emotional and uncontrolled eating, the subfacets 'accepting and non-attached attitude toward one's own eating experience', 'eating in response to awareness of fullness', and the 'awareness of eating triggers and motives' additionally showed a significant influence. CONCLUSION: ME seems a valuable approach in clarifying how mindfulness might impact eating and weight-related issues. Beyond that, it might be beneficial for upcoming interventions to strengthen specific ME subfacets, depending on the focused outcomes. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems.

PURPOSE: Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. METHODS: Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. RESULTS: WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. CONCLUSION: The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention. LEVEL OF EVIDENCE: Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.

Do Children With Functional Abdominal Pain Benefit More From a Pain-Specific Cognitive-Behavioral Intervention Than From an Unspecific Attention Control Intervention? Results of a Randomized Controlled Trial.

INTRODUCTION: We aimed to compare the efficacy of cognitive-behavioral therapy (CBT) among children with functional abdominal pain with an attention control (AC), hypothesizing the superiority of CBT group intervention regarding pain intensity (primary outcome), pain duration and frequency (further primary outcomes), functional disability, and quality of life and coping strategies (key secondary outcomes). METHODS: We conducted a prospective, multicenter, randomized controlled efficacy trial (RCT) with 4 time points (before intervention, after intervention, 3-month follow-up, and 12-month follow-up). One hundred twenty-seven children aged 7-12 years were randomized to either the CBT (n = 63; 55.6% girls) or the AC (n = 64; 57.8% girls). RESULTS: Primary endpoint analysis of the logarithmized area under the pain intensity curve showed no significant difference between groups (mean reduction = 49.04%, 95% confidence interval [CI] -19.98%-78.36%). Treatment success rates were comparable (adjusted odds ratio = 0.53, 95% CI 0.21-1.34, number needed to treat = 16). However, time trend analyses over the course of 1 year revealed a significantly greater reduction in pain intensity (40.9%, 95% CI 2.7%-64.1%) and pain duration (43.6%, 95% CI 6.2%-66.1%) in the CBT compared with the AC, but not in pain frequency per day (1.2, 95% CI -2.7 to 5.2). In the long term, children in the CBT benefitted slightly more than those in the AC with respect to functional disability, quality of life, and coping strategies. DISCUSSION: Both interventions were effective, which underlines the role of time and attention for treatment efficacy. However, in the longer term, CBT yielded more favorable results.

A prospective investigation of developmental trajectories of psychosocial adjustment in adolescents facing a chronic condition - study protocol of an observational, multi-center study.

BACKGROUND: Relatively little is known about protective factors and the emergence and maintenance of positive outcomes in the field of adolescents with chronic conditions. Therefore, the primary aim of the study is to acquire a deeper understanding of the dynamic process of resilience factors, coping strategies and psychosocial adjustment of adolescents living with chronic conditions. METHODS/DESIGN: We plan to consecutively recruit N = 450 adolescents (12-21 years) from three German patient registries for chronic conditions (type 1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). Based on screening for anxiety and depression, adolescents are assigned to two parallel groups - "inconspicuous" (PHQ-9 and GAD-7 < 7) vs. "conspicuous" (PHQ-9 or GAD-7 ≥ 7) - participating in a prospective online survey at baseline and 12-month follow-up. At two time points (T1, T2), we assess (1) intra- and interpersonal resiliency factors, (2) coping strategies, and (3) health-related quality of life, well-being, satisfaction with life, anxiety and depression. Using a cross-lagged panel design, we will examine the bidirectional longitudinal relations between resiliency factors and coping strategies, psychological adaptation, and psychosocial adjustment. To monitor Covid-19 pandemic effects, participants are also invited to take part in an intermediate online survey. DISCUSSION: The study will provide a deeper understanding of adaptive, potentially modifiable processes and will therefore help to develop novel, tailored interventions supporting a positive adaptation in youths with a chronic condition. These strategies should not only support those at risk but also promote the maintenance of a successful adaptation. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00025125 . Registered on May 17, 2021.

Getting a deeper understanding of mindfulness in the context of eating behavior: Development and validation of the Mindful Eating Inventory.

PURPOSE: Current research supports the effectiveness of mindfulness-based interventions for maladaptive eating behaviors associated with obesity and eating disorders. To investigate potential underlying mechanisms at work, reliable and valid instruments that allow for an exhaustive assessment of the context-specific construct Mindful Eating (ME) are needed. Therefore, the current work aimed to develop a comprehensive inventory reflecting a wide range of ME attitudes and behaviors: The Mindful Eating Inventory (MEI). METHODS & RESULTS: Study 1 describes the item pool development for an initial version of the MEI comprising various steps (compilation of items, expert ratings, focus groups and think aloud protocols by laypersons). Within Study 2, the factor structure of this initial version was explored in an online sample of N = 828 participants and the item pool was shortened via a sequential process based on statistical and content-related considerations. Exploratory factor analyses yielded a seven-factor structure. This structure could be confirmed within Study 3 on an independent online sample of N = 612 participants using confirmatory factor analysis. Criterion validity was supported by hypotheses-confirming correlations with eating-specific and global health-relevant outcomes. CONCLUSION: Our findings demonstrate that the MEI is a valid and reliable (in terms of internal consistency and retest-reliability) tool, which allows for a comprehensive assessment of various ME attitudes and behaviors within one parsimonious inventory. It further enabled us to propose a so far missing, initial scientific operational definition of this eating-specific construct, that may help to advance future research and clinical application by clarifying mechanisms of action.

Justice sensitivity and rejection sensitivity as predictors and outcomes of eating disorder pathology: A 5-year longitudinal study.

OBJECTIVE: Rejection sensitivity and justice sensitivity are personality traits that are characterized by frequent perceptions and intense adverse responses to negative social cues. Whereas there is good evidence for associations between rejection sensitivity, justice sensitivity, and internalizing problems, no longitudinal studies have investigated their association with eating disorder (ED) pathology so far. Thus, the present study examined longitudinal relations between rejection sensitivity, justice sensitivity, and ED pathology. METHOD: Participants (N = 769) reported on their rejection sensitivity, justice sensitivity, and ED pathology at 9-19 (T1), 11-21 (T2), and 14-22 years of age (T3). RESULTS: Latent cross-lagged models showed longitudinal associations between ED pathology and anxious rejection sensitivity, observer and victim justice sensitivity. T1 and T2 ED pathology predicted higher T2 and T3 anxious rejection sensitivity, respectively. In turn, T2 anxious rejection sensitivity predicted more T3 ED pathology. T1 observer justice sensitivity predicted more T2 ED pathology, which predicted higher T3 observer justice sensitivity. Furthermore, T1 ED pathology predicted higher T2 victim justice sensitivity. DISCUSSION: Rejection sensitivity-particularly anxious rejection sensitivity-and justice sensitivity may be involved in the maintenance or worsening of ED pathology and should be considered by future research and in prevention and treatment of ED pathology. Also, mental health problems may increase rejection sensitivity and justice sensitivity traits in the long term.

Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis.

BACKGROUND: Weight-related stigmatization is a widespread problem. Particularly the internalization of weight-related stereotypes and prejudices (weight bias internalization, WBI) is related to mental and physical health impairments. To date, little is known about the risk factors of WBI. Previous studies are mainly cross-sectional and based on adult samples. As childhood is a sensitive period for the development of a healthy self-concept, we examined predictors of WBI in children. METHODS: The final sample included 1,463 schoolchildren (6-11 years, 51.7% female) who took part in a prospective study consisting of three measurement waves. The first two waves delivered data on objective weight status and self-reported weight-related teasing, body dissatisfaction, relevance of one's own figure, self-esteem and depressive symptoms; WBI was measured during the third wave. To examine predictors of WBI, we ran hierarchical regression analyses and exploratory mediation analyses. RESULTS: Lower parental education level, higher child weight status, female gender, experience of teasing, higher body dissatisfaction, higher figure-relevance, and higher depression scores were found to be predictive for higher WBI scores. Body dissatisfaction (only for girls) and the relevance of one's own figure (both genders) mediated the association between self-esteem and WBI; no weight-related differences were observed. CONCLUSIONS: Our study offers longitudinal evidence for variables that enable the identification of children who are at risk for WBI. Thus, the findings deliver starting points for interventions aimed at the prevention of adverse health developments that come along with WBI.

Psychometric Properties of Figure Rating Scales in Children: The Impact of Figure Ordering.

This study examined psychometric properties of figure rating scales, particularly the effects of ascending silhouette ordering, in 153 children, 9 to 13 years old. Two versions of Collins's (1991) figural rating scale were presented: the original scale (figures arranged ascendingly) and a modified version (randomized figure ordering). Ratings of current and ideal figure were elicited and body dissatisfaction was calculated. All children were randomly assigned to one of two subgroups and completed both scale versions in a different sequence. There were no significant differences in figure selection and body dissatisfaction between the two figure orderings. Regarding the selection of the current figure, results showed that girls are more affected by the silhouette ordering than boys. Our results suggest that figure rating scales are both valid and reliable, whereby correlation coefficients reveal greater stability for ideal figure selections and body dissatisfaction ratings when using the scale with ascending figure ordering.

Exploring the reciprocal relationships between adolescents' perceptions of parental and peer attachment and disordered eating: A multiwave cross-lagged panel analysis.

OBJECTIVE: This prospective study explored bidirectional associations between attachment quality towards mother, father, and peers and disordered eating among a large population-based sample of boys and girls in the transition from preadolescence to adolescence. Specifically, we examined whether insecure attachment relationships emerged as a risk factor for or as an outcome of disordered eating. METHOD: A population-based sample of 904 adolescent girls and boys was assessed four times, at baseline (T1; Mage = 10.8 years) and at 2-, 4-, and 6-year follow-up (T2, T3, and T4). Prospective data were analyzed using cross-lagged panel models for each attachment figure (i.e., mother, father, peers) in a multigroup design to compare genders. RESULTS: Better attachment to the mother led to less pronounced disturbed eating in girls across the entire age range and in boys across two time periods. In girls, more pronounced disordered eating at T3 predicted worse attachment to the mother at T4 and better attachment to the father at T1 predicted less disturbed eating at T2. In boys, disordered eating at T1 predicted better attachment to the father at T2. Concerning peer attachment, better attachment at T1 predicted disordered eating at T2, in boys only. No other significant cross-lagged effects emerged. DISCUSSION: These findings highlight the differential and gender-specific contribution of attachment figures to the development of disordered eating in adolescence. Programs aimed at improving communication and trust in the relationship with parents might be promising in the prevention of disordered eating and the subsequent deterioration of parent-child attachment relationships.

Quality of life among parents seeking treatment for their child's functional abdominal pain.

PURPOSE: Dealing with a child who suffers from functional abdominal pain (FAP) is a major challenge for the child's parents. However, little is known about the quality of life (QoL) of this group of parents. Therefore, this cross-sectional study aimed to provide a comprehensive analysis of parental QoL among parents seeking treatment for their child's abdominal pain. METHODS: 133 parents of 7-13-year-old children diagnosed with FAP reported on their health-related QoL (HRQoL), as assessed by the SF-12, and on caregiver-related QoL, as assessed by two CHQ-PF50 scales (emotional impact, time impact). T tests were used to compare the parents' scores on these measures with reference scores. Subgroups which were at risk of impairment were defined by cut-off scores. Determinants of parental QoL were identified by hierarchical regression analyses. RESULTS: While the parents showed significantly poorer mental health compared to population-based reference samples (d = 0.33-0.58), their physical health did not differ. However, parents were severely strained with respect to the time impact and emotional impact of their child's health (d = 0.33-1.58). While 12.7-27.9% of the parents were at risk of poor HRQoL, 60.6-70.1% were highly strained due to the demands of their role as caregivers. Physical and mental health were best explained by parents' psychiatric symptoms, while parents' perception of their child's impairment additionally determined the high time and emotional impact. CONCLUSIONS: Physical HRQoL is not impaired in the majority of parents seeking treatment for their child's functional abdominal pain. However, the time demands and worries due to the child's pain deserve specific attention. Psychosocial interventions for a child's FAP should include information provided to the parents about coping with time constraints and emotional impact. Further prospective studies are warranted.

Battle of plates: a pilot study of an approach-avoidance training for overweight children and adolescents.

OBJECTIVE: Approach-avoidance training (AAT) is a promising approach in obesity treatment. The present study examines whether an AAT is feasible and able to influence approach tendencies in children and adolescents, comparing implicit and explicit training approaches. Design/Setting/Subjects Fifty-nine overweight children and adolescents (aged 8-16 years; twenty-six boys) participated in an AAT for food cues, learning to reject snack items and approach vegetable items. Reaction times in the AAT and an implicit association test (IAT) were assessed pre- and post-intervention. RESULTS: A significant increase in the AAT compatibility scores with a large effect (η 2=0·18) was found. No differences between the implicit and explicit training approaches and no change in the IAT scores were observed. CONCLUSIONS: Automatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.

The NutriAct Family Study: a web-based prospective study on the epidemiological, psychological and sociological basis of food choice.

BACKGROUND: Most studies on food choice have been focussing on the individual level but familial aspects may also play an important role. This paper reports of a novel study that will focus on the familial aspects of the formation of food choice among men and women aged 50-70 years by recruiting spouses and siblings (NutriAct Family Study; NFS). METHODS: Data is collected prospectively via repeatedly applied web-based questionnaires over the next years. The recruitment for the NFS started in October 2016. Participants are recruited based on an index person who is actively participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. This index person was asked to invite the spouse, a sibling or an in-law. If a set of family members agreed to participate, access to individualized web-based questionnaires assessing dietary intake, other health related lifestyle habits, eating behaviour, food responsiveness, personality, self-regulation, socio-economic status and socio-cultural values was provided. In the first phase of the NSF, recruitment rates were monitored in detail and participants' comments were analysed in order to improve the feasibility of procedures and instruments. DISCUSSION: Until August 4th 2017, 4783 EPIC-Participants were contacted by mail of which 446 persons recruited 2 to 5 family members (including themselves) resulting in 1032 participants, of whom 82% had started answering or already completed the questionnaires. Of the 4337 remaining EPIC-participants who had been contacted, 1040 (24%) did not respond at all, and 3297 (76%) responded but declined, in 51% of the cases because of the request to recruit at least 2 family members in the respective age range. The developed recruitment procedures and web-based methods of data collection are capable to generate the required study population including the data on individual and inter-personal determinants which will be linkable to food choice. The information on familial links among the study participants will show the role of familial traits in midlife for the adoption of food choices supporting healthy aging.