Health Mindsets in Pediatric Chronic Headache.

OBJECTIVE: Given how frequently youth with chronic headache and migraine experience setbacks in treatment, identifying factors that promote coping and resilience is critical. Mindsets have gained attention as predictors of behavior and targets of intervention across contexts, including health. Health mindsets may help to explain how children with chronic pain interpret and respond to treatment. This study evaluated whether growth health mindsets might relate to adaptive outcomes in patients with chronic pediatric headache. METHODS: Participants were 88 children and adolescents (ages 10-17 years) with headache or migraine contacted following an appointment at a pediatric headache clinic, and their parent. Patients rated their beliefs about health as more fixed versus growth-oriented. They were presented with vignettes depicting hypothetical treatment setbacks and instructed to reflect upon real-life setbacks. Patients completed questionnaires about their cognitive appraisals of setbacks, coping, quality of life, life satisfaction, and functional impairment. RESULTS: The higher children rated their growth health mindsets, the less likely they were to appraise setbacks as threatening and endorse quality-of-life problems. Children with higher growth mindsets reported higher life satisfaction and lower functional disability. There was also an indirect relation between children's mindsets and coping through cognitive appraisals of setbacks as a threat, but not challenge. CONCLUSION: This research extends the health mindsets literature by contributing preliminary evidence of health mindsets as tied to adaptive outcomes in youth with chronic headache. These findings may be of interest to clinicians and parents, as health mindsets may offer an avenue by which resilience is promoted and maladaptive appraisals are minimized.

Parental Autonomy Support in Two Cultures: The Moderating Effects of Adolescents' Self-Construals.

Parental autonomy support has been related to positive adolescent outcomes, however, its relation to outcomes in collectivist cultural groups is unclear. This study examined relations of specific autonomy supportive behaviors and outcomes among 401 adolescents (Mage  = 12.87) from the United States (N = 245) and collectivist-oriented Ghana (N = 156). It also examined whether adolescents' self-construals moderated the relations of specific types of autonomy support with outcomes. Factor analyses indicated two types of autonomy support: perspective taking/open exchange and allowance of decision making/choice. In both countries, perspective taking/open exchange predicted positive outcomes, but decision making/choice only did so in the United States. With regard to moderation, the more independent adolescents' self-construals, the stronger the relations of decision making/choice to parental controllingness and school engagement.

Adolescent adjustment in the context of life change: the supportive role of parental structure provision.

This study examined the associations among disruptive life events, supportive parenting practices, adolescent self-perceptions, and emotional outcomes. One-hundred and three 7th graders (68% minority, 32% European American) and their parents completed recent negative life events checklists. Parents also reported the total number of major transitions (changes in residences, schools, parent's romantic partners) that adolescents experienced since birth. Life events were related to lower adolescent-reported perceptions of competence and control, higher adolescent-reported depression and behavior problems, and higher parent-reported conduct problems. Regression analyses supported a mediational model in which competence and control perceptions explained relations between adolescent life events and symptomatology. Parental structure-the provision of clear, consistent and predictable rules and expectations-was associated with more adaptive adolescent functioning, especially among girls. Regressions indicated that structure related to higher perceptions of competence and control and fewer behavioral problems, even after accounting for the risk associated with negative life events and transitions.

The role of expectations in children's experience of novel events.

The expectations children bring to interactions, as well as the information they receive prior to them, may be important for children's experiences of new adults. In this study, 148 children (8-13 years old) reported on their expectations of adults, received one of three types of information about a new adult (positive, realistic, or control), and then "interacted" with a videotaped "controlling" adult. The effect of information type depended on children's age and prior expectations, with expectancy effects emerging in the context of positive information at the younger end of our age range and in the context of realistic information at the older end of our age range. Furthermore, the more expectations exceeded perceptions (i.e., the more disappointment), the lower children's rapport, affect, and prosocial intentions were and the more internal causal attributions they made. Results are discussed in terms of their theoretical and applied contributions.

Parenting, self-regulation, and treatment adherence in pediatric chronic headache: A self-determination theory perspective.

This study examined parenting factors associated with children's self-regulation and physician-rated treatment adherence using a self-determination theory framework in pediatric chronic headache. Participants were 58 children and adolescents (aged 10-17 years), who underwent initial and follow-up multidisciplinary evaluation at a headache clinic, and their mothers. Regression analyses showed that higher maternal autonomy support and structure were significantly related to children's lower treatment-related reactance and higher adherence. Maternal controllingness had associations in the opposite directions. Children's fear of pain was related to maternal controllingness. Results suggest the importance of parents' provision of clear expectations and engaging children in treatment problem-solving and decision-making.

Improving adjustment and resilience in children following a disaster: Addressing research challenges.

There is compelling evidence of the potential negative effects of disasters on children's adjustment and functioning. Although there is an increasing base of evidence supporting the effectiveness of some interventions for trauma following disaster, more research is needed, particularly on interventions that can be delivered in the early aftermath of disaster as well as those that can address a broader range of adjustment difficulties such as bereavement that may be experienced by children after a disaster. This article identifies gaps in the knowledge of how best to intervene with children following disasters. Key challenges in conducting research in disaster contexts, including obtaining consent, designing rigorous studies, and obtaining funding quickly enough to conduct the study, are discussed. Several strategies hold promise to address research challenges in disasters, including using alternative designs (e.g., propensity scores, matched control groups, group-level assignment), working with schools and communities, and studying implementation of nontraditional modes of intervention delivery. (PsycINFO Database Record

Evaluative pressure in mothers: effects of situation, maternal, and child characteristics on autonomy supportive versus controlling behavior.

This study examined the effects of situational pressure and maternal characteristics (social contingent self-worth, controlling parenting attitudes) on mothers' autonomy support versus control in the social domain. Sixty 4th-grade children and their mothers worked on a laboratory task in preparation for meeting new children, with mothers in either an evaluation (mothers told their child would be evaluated by other children) or no-evaluation (no mention of evaluation) condition. Mothers in the evaluation condition spent more time giving answers to their children. Mothers with controlling parenting attitudes exhibited more controlling behavior. Further, mothers with high social contingent self-worth in the evaluation condition were most controlling. Results suggest the importance of interactions between situations and maternal characteristics in determining levels of mothers' autonomy support versus control and have implications for helping parents support children's autonomy.

Antecedents and consequences of mothers' autonomy support: an experimental investigation.

This study examined the effects of contextual and individual differences on mothers' autonomy support versus control on homeworklike tasks. Sixty mothers and their third-grade children worked on map and poem tasks, with mothers in either an ego-involving (high pressure) or a non-ego-involving (low pressure) condition. Later, children worked on similar tasks themselves. Mothers in the high-pressure condition were more controlling on the poem task. For the map task, mothers who came in with controlling styles and received the high-pressure manipulation were most controlling. Children whose mothers interacted in a more controlling manner wrote less creative poems when alone. Results suggest the importance of context, children's competence levels, and mothers' styles in determining levels of autonomy support.

Children's engagement and competence in personal recollection: effects of parents' reminiscing goals.

Parents' goal orientations in parent-child reminiscing were examined in this study, where 28 preschoolers (mean age = 46 months) experienced a standardized event. Dyads discussed the event that evening, with parents randomly assigned to either an "outcome-oriented" or a "process-oriented" condition. Outcome-oriented parents, who were told that children subsequently would be tested on event-related recall, were more controlling in these conversations compared with process-oriented parents, who were told that children's personal perspective would be assessed. Parents did not differ in their provision of structure. Children were interviewed 2 weeks later. Autonomy support in the parent-child conversation predicted children's engagement in the interview. Parental structure predicted children's recall of details and the coherence of their memories. Effects of parental reminiscing styles for children's memory and motivation to reminisce are discussed.

Children's expectancies and perceptions of adults: effects on rapport.

Interpersonal expectancy effects are less thoroughly understood in children than in adults, yet they can have practical implications for children's interactions. To understand better children's expectancies, this study extended earlier work to include expectancies of adults, preexisting (i.e., noninduced) expectancies, and joint effects of expectancies and subsequent perceptions. Children (N = 81) in Grades 4 through 6 (i.e., 9- to 12-year-olds) indicated their expectancies of adults who subsequently interacted with them using a style of either autonomy support (AS) or control (CN). After each interaction, children reported on perceived AS and on rapport. Results indicated that children's expectancies and subsequent perceptions interact to predict rapport, adult AS is associated with increased rapport, and the effect of children's expectancies on rapport is only partially mediated by their perceptions.