Handling missing data in longitudinal clinical trials: three examples from the pediatric psychology literature
Researchers by default tend to choose complex models when analyzing nonindependent response variable data, this may be particularly applicable in the analysis of longitudinal trial data, possibly due to the ability of such models to easily address missing data by default. Both maximum-likelihood (ML) estimation and multiple imputation (MI) are well-known to be acceptable methods for handling missing data, but much of the recently published quantitative literature has addressed questions regarding the research designs and circumstances under which one should be chosen over the other. The purpose of this article is threefold. First, to clearly define the assumptions underlying three common longitudinal trial data analysis models for continuous dependent variable data: repeated measures analysis of covariance (RM-ANCOVA), generalized estimating equation (GEE), and a longitudinal linear mixed model (LLMM). Second, to clarify when ML or MI should be chosen, and to introduce researchers to an easy-to-use, empirically well-validated, and freely available missing data multiple imputation program: BLIMP. Third, to show how missing longitudinal trial data can be handled in the three data analysis models using three popular statistical analysis software packages (SPSS, Stata, and R) while keeping the published quantitative research in mind.
Insomnia severity and obesity mediated by health behaviors in adolescents
Sleep difficulties in youth have been associated with numerous negative outcomes, such as higher risk of obesity. Though the relationship between sleep and obesity is not well clarified, past research has shown that modifiable health behaviors, such as diet, physical activity, and screen time, may explain this relationship. The purpose of this study was to simultaneously examine these health behaviors as mediators of the relationship between insomnia severity and obesity among a sample of adolescents aged 12-18 years.
Systematic review and meta-analysis of combined cognitive-behavioral therapy and physical activity and exercise interventions for pediatric chronic disease
Cognitive-behavioral (CBT) interventions combined with either a physical activity (CBT+PA) or exercise intervention (CBT+Ex) are becoming more common in pediatric populations. Considering the independent effects of PA and exercise on health and psychological outcomes, it is unclear whether CBT alone differs from CBT+PA or CBT+Ex in efficacy. The main objective of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to assess the efficacy of CBT+PA and CBT+Ex interventions in pediatric chronic disease.
Temporal summation of pain in sickle cell disease: comparison of adolescents and young adults with chronic vs. infrequent pain
This study examined the role of central sensitization in the experience of pain among adolescents and young adults with the most severe genotypes of sickle cell disease (SCD). We hypothesized that adolescents and young adults with chronic SCD pain would demonstrate a higher perceptual response to repeated stimulation of identical intensity (i.e., temporal summation of pain, TSP) compared to counterparts with infrequent pain. We also examined psychological risk factors that can impact pain sensitivity.
Caregivers' physiological responses during toddler vaccinations: associations with psychological and behavioral responses
This study investigated biological, psychological, and behavioral aspects of caregivers' responses to toddlers' pain-related distress by measuring caregivers' high-frequency heart rate variability (HRV) responses during toddler vaccination pain and examining associations with caregivers' behavioral responses and psychological stress.
A qualitative account of mothers of pediatric heart transplant recipients' experience at a pilot mindfulness-based retreat: insights for implementation
To explore participants' shared experience attending a pilot mindfulness-based retreat (MBR) intervention supporting the psychological well-being of mothers of pediatric heart transplant (HTx) recipients.
Latent profiles and predictors of barriers to care in Swiss children and adolescents with rare diseases
Children and adolescents with rare diseases face significant barriers when accessing healthcare. We aimed to assess and predict these barriers and investigate associations with health-related quality of life (HRQoL).
Systematic review and meta-analysis of the effect of psychological interventions on anxiety in children and youth with chronic medical conditions
Anxiety disorders affect 20%-50% of youth with chronic medical conditions (CMCs) and can interfere with medical care and treatment outcomes. Psychological therapies are typically designed for youth without CMCs; thus, this systematic review (Open Science Framework preregistration osf.io/a52nd/) assesses the effect of psychological therapies on anxiety, functional impairment and health-related quality of life (HRQOL) in this unique population.
Posttraumatic stress symptoms in parents of children with newly diagnosed cancer: 1-year trajectories and relationship variables as predictors
The way in which parental posttraumatic stress symptoms (PTSS) unfold in the first year after a cancer diagnosis in their child is poorly understood. The aims of this study were to identify parental PTSS trajectories and to examine couple-related predictors (dyadic coping and we-disease appraisals), sociodemographic predictors (education and sex), and medical predictors (child's physical impairment) of trajectory membership.
"Being alone for a whole year [is hard]" Families reflect on the emotional toll of stem cell transplantation for sickle cell disease
Sickle cell disease (SCD) is associated with significant morbidity and mortality. Hematopoietic stem cell transplantation (HCT) can improve health-related quality of life (HRQOL) but may be physically and emotionally challenging. Thus, the aim of this study was to understand the experience of HCT from the perspective of youth and young adults (YYAs) post-HCT for SCD and their parents.
The critical need for expert oversight of ChatGPT: Prompt engineering for safeguarding child healthcare information
ChatGPT and other large language models have the potential to transform the health information landscape online. However, lack of domain-specific expertise and known errors in large language models raise concerns about the widespread adoption of content generated by these tools for parents making healthcare decisions for their children. The aim of this study is to determine if health-related text generated by ChatGPT under the supervision of an expert is comparable to that generated by an expert regarding persuasiveness and credibility from the perspective of a parent.
Commentary: The integration of sleep health education into diabetes care for adolescents with Type 1 diabetes
Associations between tripartite dimensions of internalizing symptoms and transition readiness in a sample of emerging adults with and without chronic physical health conditions
Theoretical models note psychosocial functioning as a key influence on transition readiness skills (TRS) among emerging adults (EA), but little is known about the relative importance of unique vs. shared anxiety and depressive dimensions, operationalized according to Clark and Watson's (1991) tripartite model, in contributing to TRS. Moreover, although development of TRS is important for all EA, few studies have examined whether the strength of relationships between internalizing symptoms and TRS vary between EA with and without chronic physical health conditions (CHC). Given the links between suboptimal TRS and adverse health outcomes, additional research is needed. This study examined individual and additive associations between three internalizing symptom dimensions (anxious arousal, anhedonic depression, and general distress) and TRS, as well as the moderating role of CHC status.
Inclusive measure development: amplifying the voices of adolescents and young adults with spina bifida in a new measure of benefit-finding and growth
Benefit-finding and growth is an important process across a range of medical populations. However, it has been understudied in the context of lifelong chronic conditions, such as spina bifida (SB). This study aimed to develop a new measure of benefit-finding and growth for youth with SB, confirm its factor structure, and examine its psychometric properties.
Supporting emotion regulation in children on the autism spectrum: co-developing a digital mental health application for school-based settings with community partners
KeepCalm is a digital mental health application, co-designed with community partners, that incorporates wearable biosensing with support for teams to address challenging behaviors and emotion dysregulation in children on the autism spectrum.
Developmental changes in how pedestrians cross streets in single- vs. dual-lane traffic conditions
Pedestrian injury is a leading contributor to childhood deaths. This study compared the crossing behaviors of children with adults when crossing in virtual single-lane vs. two-lane traffic conditions.
Examining the psychometric properties of the CEFIS-AYA using item response theory
The COVID-19 Exposure and Family Impact Scale, Adolescent and Young Adult Version (CEFIS-AYA; Schwartz, L. A., Lewis, A. M., Alderfer, M. A., Vega, G., Barakat, L. P., King-Dowling, S., Psihogios, A. M., Canter, K. S., Crosby, L., Arasteh, K., Enlow, P., Hildenbrand, A. K., Kassam-Adams, N., Pai, A., Phan, T. L., Price, J., Schultz, C. L., Sood, E., Wood, J., & Kazak, A. (2022). COVID-19 exposure and family impact scales for adolescents and young adults. Journal of Pediatric Psychology, 47, 631-640. https://doi.org/10.1093/jpepsy/jsac036) was developed to assess the pandemic's effects on adolescents and young adults (AYA). Via principal component analysis, measure developers examined the structure and reliability of the CEFIS-AYA and identified seven exposure and five impact components. This study built upon prior work through use of item response theory (IRT) models to characterize the dimensionality of the CEFIS-AYA, determine the strength of relations between items and underlying trait(s), and examine associations between trait scores and pandemic-related distress.
The association of resilience with HbA1c and key psychosocial factors in emerging adults with type 1 diabetes
Emerging adults (EAs) with type 1 diabetes (T1D) have difficulty meeting glycemic targets and have a high prevalence of mental health comorbidities. Resilience, the ability to harness resources needed to sustain one's emotional and physical well-being, may be a key factor impacting poor mental health and glycemic outcomes. We aimed to (a) evaluate the association between resilience, HbA1c, and key psychosocial factors and (b) explore whether resilience moderates the relationship between psychosocial factors (depression, diabetes-related distress, anxiety) and HbA1c in EAs with T1D.
Sexual and reproductive health guidelines for Black girls: a call to action
Black girls disproportionately face adverse sexual and reproductive health outcomes in their lifetime. In healthcare, Black girls experience racism and misogyny, which manifest as a combination of discriminatory practices and biases that result in their symptoms being dismissed or neglected, their voices silenced, inadequate treatment, and higher mortality rates. Pediatric providers are in an ideal position to influence, advocate, and strengthen Black girls' sexual and reproductive health. The purpose of this topical review is to discuss current guidelines and provide recommendations to improve pediatric sexual and reproductive care for Black girls.
Achieving RoutIne Screening for Emotional health (ARISE) in pediatric subspecialty clinics
This study aims to describe the experience of implementing a psychosocial distress screening system for children with serious or chronic medical conditions.
Barriers to healthy behaviors: perspectives from teens with comorbid Type 1 diabetes and overweight/obesity, caregivers, and pediatric endocrinologists
This study aimed to understand barriers to engagement in healthy lifestyle behaviors among adolescents with comorbid Type 1 diabetes (T1D) and overweight/obesity (n = 12), their caregivers (n = 12), and pediatric endocrinologists (n = 9).
Pilot study of a parent-based intervention for functional somatic symptoms in children
Functional somatic symptoms are associated with significant distress and impairment for children and their families. Despite the central role that families play in their children's care, there is little clinical research to guide how parents can support their children with functional somatic symptoms and promote better functioning. To address this gap, we developed a parent-based intervention for functional somatic symptoms in children and obtained preliminary data on acceptability, feasibility, treatment satisfaction, and clinical outcomes.
Family communication and courageous coping in Korean adolescents and young adults: a cross-sectional study
Adolescents and young adults (AYAs) with cancer are a vulnerable population during a critical developmental transition that can benefit from the adoption of courageous coping. Parental support is crucial in enhancing adjustment and coping skills. The linkage between parent-adolescent communication (PAC) and the use of courageous coping (UCC), however, remains unclear. This study examined the association between PAC and UCC and possible mediators of this relationship among Korean AYAs with cancer.
A randomized controlled trial to test the efficacy of a brief Triple P discussion group to increase healthy feeding practices and reduce risk factors for infant obesity
Test the efficacy of a brief 2-hr parenting intervention in increasing protective factors against and reducing risk factors for infant obesity.
Cognitive and affective links between childhood adversity and psychological adjustment in emerging adults with chronic medical conditions
Childhood adversity has been linked to poor psychological adjustment and decreased emotion regulation (ER) abilities. The extended process model of ER outlines the pivotal role of cognitive appraisals in the generation and expression of emotion as well as the pursuit of ER. The aim of the current study is to examine whether illness-related cognitive appraisals (i.e., illness uncertainty and illness intrusiveness) and emotion dysregulation serially mediate the relationship between childhood adversity and psychological adjustment for emerging adults with chronic medical conditions (CMCs).
Child mental health treatment access and retention in integrated primary care and traditional outpatient services
There are disparities in child mental health treatment access and treatment retention in terms of race and ethnicity, socioeconomic status (SES), and insurance coverage. Institutions have invested in the integrated primary care (IPC) treatment model with the goal of improving treatment access and promoting child mental health equity.
Feasibility and acceptability of a telehealth, individually-tailored healthy lifestyle intervention for adolescent and young adult pediatric cancer survivors
Poor nutrition and physical activity pose negative health risks for adolescent and young adult pediatric cancer survivors (AYACS). Our pilot randomized controlled trial (RCT) evaluated feasibility and acceptability of a telehealth intervention (ENHANCE) supporting AYACS' nutrition and physical activity.
Modernizing behavioral parent training program for ADHD with mHealth strategies, telehealth groups, and health behavior curriculum: a randomized pilot trial
Parent behavior management training (BMT) is an evidence-based yet underutilized tool to treat children with ADHD and address related health disparities. This pilot study investigated the acceptability and feasibility of a novel, health behavior-, and technology-adapted BMT (LEAP) vs. standard BMT.
Commentary: Considering the Clinical Implications of "A Systematic Review and Meta-Analysis of Adherence Interventions for Youth and Young Adults"
Commentary: A perfectly imperfect approach to reducing risk for pediatric anxiety