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Biomedical subjects

A M La Greca

Publications and source records attributed to A M La Greca.

At least 19 recordsLinked to original sources

Parenting styles, regimen adherence, and glycemic control in 4- to 10-year-old children with diabetes.

OBJECTIVE: To examine relationships among parenting styles, regimen adherence, and glycemic control for preschool and elementary school children who have Type I diabetes. METHODS: Parents of 55 children with diabetes completed parenting style and regimen adherence questionnaires. Glycosylated hemoglobin results were collected by chart review. RESULTS: Parental warmth was associated with better adherence ratings. Regression analyses showed that parental warmth explained 27% of the variance in adherence ratings. Parental restrictiveness was associated with worse glycemic control in univariate analyses. However, only Black ethnicity, not adherence or parenting variables, predicted glycemic control. Black ethnicity and lower socioeconomic status (SES) were associated with more parental restrictiveness and worse glycemic control. CONCLUSIONS: These results suggest that authoritative parenting, characterized by support and affection, may be advantageous for the regimen adherence and glycemic control of school-age and younger children with diabetes. Demographic characteristics are important and require further study in this context.

Child↗

Early life stress and disease among offspring and siblings of individuals with type 1 diabetes mellitus.

Major life events, recent life stressors, and childhood diseases were examined among children and adolescents who were offspring, siblings, or other relatives of persons with type 1 diabetes mellitus (DM). All youth were recruited as part of a multi-site nationwide trial on the prevention of type 1 DM; parents of 347 children (4 to 18 yr) completed measures that asked about children's life events, recent stressors, and childhood illnesses. Analyses compared age groups (young child, preadolescent, adolescent) and relative type (offspring, sibling, other relative). Findings revealed offspring and siblings did not differ from "other relatives" in terms of life events, recent life stress, and disease/illness variables. However, siblings were reported to have fewer major life events and fewer life stressors in the past 12 months than offspring; siblings also had fewer infectious diseases during the first two years of life compared to offspring. Few age-related differences were found. Overall, results suggest that offspring and siblings of persons with type 1 DM are not at a disadvantage in terms of early life stress or disease in comparison to youth who have other family members with diabetes. However, siblings may have some advantages relative to children who are offspring. The mechanisms underlying these relationships require further elucidation and study.

Aging↗

What do youth referred for anxiety problems worry about? Worry and its relation to anxiety and anxiety disorders in children and adolescents.

This study examined worry and the parameters of worry that may be associated with clinical anxiety in a sample of 119 children and adolescents referred to a childhood anxiety disorders specialty clinic. Using an interviewing procedure, results indicated that the types of worries reported by the children were similar to those reported in previous studies of nonreferred community children. Also similar to previous community studies were findings showing moderate but significant correlations between different indices of worry (i.e., number, intensity, and frequency of the worries) and children's scores on self-rating scales of anxiety. Results further indicated that worry contributed additional variance beyond that of anxiety in predicting fear. In addition, intensity differentiated clinic children's worries from nonreferred children's. Intensity and number of worries differentiated subsamples of children within the clinic-referred sample (i.e., children with overanxious disorder or generalized anxiety disorder and children with simple phobia). The importance of examining children's worries to further understand anxiety and its disorders in youth is discussed.

Adolescent↗

Links between mothers' and children's social competence and associations with maternal adjustment.

Extended previous research on family factors related to children's social competence by examining links between 3 domains of maternal social competence (social skills, social frames, network size) and 3 domains of children's social competence (social skills, peer-rated social preference, and network size) in a sample of 78 mothers and their kindergarten children (42 girls, 36 boys). The mediational role of maternal social competence in the association between mothers' depression and interpersonal sensitivity symptoms and children's social competence was also tested. Results supported associations between all 3 domains of mothers' and children's social competence, with maternal social skills the most frequent predictor of children's social competence. Gender differences suggested that maternal social competence was more strongly related to sons' peer acceptance and daughters' social skills. A mediational model received preliminary support for girls, with maternal psychological symptoms related to girls' social competence via maternal social skills. Implications include the need for continued study of maternal social competence as a family factor related to children's peer functioning and the development of family-based interventions for young children experiencing peer problems.

Adult↗

United we stand, divided we fall: the education and training needs of clinical child psychologists.

Reviews efforts to delineate training needs for psychologists who are providing clinical services to children, adolescents, and families. In particular, this article (a) describes efforts of clinical child and other psychologists who work with children, adolescents, and families to develop education and training guidelines; (b) discusses the overlap among various child and adolescent providers within psychology; and (c) highlights several key competencies that have been identified as important for all psychologists in practice roles with children and adolescents. In particular, we emphasize the need for greater collaboration and integration among various psychological specialties that focus on children, adolescents, and families and for greater system-wide discussion of training needs and priorities.

Adolescent↗

Social anxiety in children with anxiety disorders: relation with social and emotional functioning.

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6-11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.

Anxiety Disorders↗

Social anxiety among adolescents: linkages with peer relations and friendships.

This study examined the utility of modifying the Social Anxiety Scale for Children-Revised (SASC-R) for use with adolescents, and examined associations between adolescents' social anxiety (SA) and their peer relations, friendships, and social functioning. Boys (n = 101) and girls (n = 149) in the 10th through 12th grades completed the Social Anxiety Scale for Adolescents (SAS-A) and measures of social support, perceived competence, and number and quality of their best friendships. Factor analysis of the SAS-A confirmed a three-factor structure: Fear of Negative Evaluation, Social Avoidance and Distress in General, and Social Avoidance Specific to New Situations or Unfamiliar Peers. Girls reported more SA than boys, and SA was more strongly linked to girls' social functioning than boys'. Specifically, adolescents with higher levels of SA reported poorer social functioning (less support from classmates, less social acceptance), and girls with higher levels of SA reported fewer friendships, and less intimacy, companionship, and support in their close friendships. These findings extend work on the SASC-R to adolescents, and suggest the importance of SA for understanding the social functioning and close friendships of adolescents, especially girls.

Adolescent↗

Children's predisaster functioning as a predictor of posttraumatic stress following Hurricane Andrew.

This study examined (a) children's predisaster behavioral and academic functioning as a predictor of posttraumatic stress (PTS) following Hurricane Andrew and (b) whether children who were exposed to the disaster would display a worsening of prior functioning. Fifteen months before the disaster, 92 4th through 6th graders provided self-reports of anxiety; peers and teachers rated behavior problems (anxiety, inattention, and conduct) and academic skills. Measures were repeated 3 months postdisaster; children also reported PTS symptoms and hurricane-related experiences (i.e., exposure). PTS symptoms were again assessed 7 months postdisaster. At 3 months postdisaster, children's exposure to the disaster, as well as predisaster ratings of anxiety, inattention, and academic skills, predicted PTS symptoms. By 7 months, only exposure, African American ethnicity, and predisaster anxiety predicted PTS. Prior anxiety levels also worsened as a result of exposure to the disaster. The findings have implications for identifying and treating children at risk for stress reactions following a catastrophic disaster.

Adjustment Disorders↗

It's "all in the family": responsibility for diabetes care.

Despite its importance, diabetes management it is an area of great difficulty for children and adolescents. As children reach the teenage years, satisfactory levels of treatment adherence and glycemic control become increasingly difficult to obtain. In order to promote better diabetes care, the present paper emphasizes the need for families to remain actively involved in their youngster's diabetes care, regardless of the child's age. Recent studies of children and adolescents with diabetes are described that support the view that, even as responsibility for diabetes care shifts from a parent-managed to an adolescent-managed system, family members should remain actively involved in day to day management. Based on current research efforts, the specific ways that family members can remain active and involved are discussed.

Adolescent↗

Reflections and perspectives on pediatric psychology: editor's vale dictum.

Reviews major activities of the Editor and changes in the Journal of Pediatric Psychology (JPP) for issues published in 1993 through 1997. Significant trends and accomplishments are reviewed, including the increased use of Special Issues and Special Sections to highlight current pediatric psychological research. Articles published during the term are analyzed in terms of article type and population type. Comparisons are made to earlier trends in JPP publications, as reported by Roberts (1992).

Humans↗

Directive and nondirective social support in diabetes management.

Directive and Nondirective Support were distinguished (interrater agreement = 88.2%) through open-ended interviews completed by 60 adults with Insulin Dependent Diabetes Mellitus. Supporting validity, the sum of both Directive and Nondirective Support was correlated with scores on the Interpersonal Support Evaluation List (ISEL; r = .36). Supporting their distinction, Directive and Nondirective Support were inversely correlated (r = -.26), and Directive but not Nondirective Support decreased with age. Partial/correlations controlled for general support as measured by the ISEL, to examine the unique associations of Directive and Nondirective Support. For those less than 30 years old, Nondirective Support was associated with better metabolic control (p = .004). For those 30 or older, Directive Support appeared counterproductive, being associated with greater negative mood (p = .02). Different types of support may play different roles in different areas of disease management (e.g., metabolic control versus mood) and as a function of individual characteristics such as age.

Journal Article↗

Prediction of posttraumatic stress symptoms in children after hurricane Andrew.

The authors used an integrative conceptual model to examine the emergence of posttraumatic stress disorder (PTSD) symptoms in 568 elementary school-age children 3 months after Hurricane Andrew. The model included 4 primary factors: Exposure to Traumatic Events, Child Characteristics, Access to Social Support, and Children's Coping. Overall, 62% of the variance in children's self-reported PTSD symptoms was accounted for by the 4 primary factors, and each factor improved overall prediction of symptoms when entered in the analyses in the order specified by the conceptual model. The findings suggest that the conceptual model may be helpful to organize research and intervention efforts in the wake of natural disasters.

Adaptation, Psychological↗

Assessment as a process in pediatric psychology.

In this editorial, we have highlighted several key aspects of the assessment process. First, we consider it critical that pediatric psychologists view "assessment as a process," and not as a test or measure. Assessment begins with the formulation of a precise, answerable question--and this maxim is equally important for researchers and clinicians. It is especially critical that research questions be conceptually based, as well as of applied interest. The development of an appropriate assessment strategy should always follow directly from the question that is posed. Second, in developing an assessment strategy, we advocate selecting the "best" informants and the "best" measurement methods available, also taking into consideration the developmental level of the participants and the types of constructs being assessed. In most cases, it will be desirable to use multiple informants, rather than relying on a single source. Given the measurement constraints discussed earlier, we also advocate using multiple measures to assess a construct, and avoiding single-item measures. We also feel strongly that pediatric psychologists should consider designing focused studies of developmentally appropriate age groups, rather than evaluating children from a very broad age range (e.g., infants to teens). Third, as pediatric psychological research moves into new areas of inquiry, assessment should represent a "growth area." We need psychometrically sound measures that are appropriate for use with pediatric health populations. We also need to develop assessment strategies that capture the rich and complex process of dealing with health and disease and, therefore, we should consider gathering qualitative data, to supplement standardized questionnaires. Finally, we recognize that pediatric psychologists face many practical constraints and challenges in the assessment process, especially in today's volatile health care climate. We have seen and will continue to see radical changes in the way health care is provided; pediatric psychologists and other care providers are continually making adjustments in their activities to respond to these frequent shifts and changes. In part because of these changes, pediatric psychologists need to develop and use methods to assess the financial costs and benefits of their interventions. With the increasing emphasis on providing quality medical care at the lowest possible price, efforts to document the valuable contributions of pediatric psychologists become paramount. By sharing our ideas and strategies, as many of the contributors to this issue have done, we stand a better chance of making a better future.

Child↗

I get by with a little help from my family and friends: adolescents' support for diabetes care.

Evaluated and compared the support provided by family members and friends for adolescents' diabetes care. Family and friend support also were examined in relation to other measures of social support, to demographic variables (age, gender, duration of diabetes) and to adherence. Using a structured interview, 74 adolescents with diabetes described the ways that family members and friends provided support for diabetes management (insulin shots, blood glucose monitoring, eating proper meals, exercise), and for helping them to "feel good about their diabetes." Families provided more support than friends for three management tasks (insulin injections, blood glucose monitoring, meals); this support was largely instrumental. In contrast, friends provided more emotional support for diabetes than families. Greater family support was related to younger age, shorter disease duration, and better treatment adherence. Implications of the findings include encouraging parents to remain involved in adolescents' treatment management, and involving peers as supportive companions for meals and exercise.

Adolescent↗

Case reports in pediatric psychology: uses and guidelines for authors and reviewers.

Described uses of case reports in pediatric psychology and guidelines for authors and reviewers. Case reports have several important functions: to document the efficacy of new treatment applications, describe interesting new clinical phenomena, to develop hypotheses, to illustrate methodological issues, difficult diagnostic issues, or novel treatment approaches, and to identify unmet clinical and research needs. Authors should carefully document the scientific purpose and clarify the new information contributed by their reports, provide evidence for their conclusions, and articulate clinical, theoretical, and/or research implications.

Child↗

What do children worry about? Worries and their relation to anxiety.

This study examined worry in elementary school aged children and its relation to anxiety. The study also examined whether parameters of excessive or dysfunctional worry could be delineated. Children from second through sixth grades (ages 7-12 years) were interviewed using a structured approach and completed several child anxiety measures. Parameters of worry assessed included: number of worries, areas of worry, intensity of worries, and perceptions of the frequency of worry events. Findings revealed few age-related differences but found that girls reported more worries than boys and that African-Americans reported more worries than white or Hispanic children. The three most common areas of worry involved School, Health, and Personal Harm. Anxiety was significantly associated with worry, providing empirical support for a link between these two constructs. Worry parameters, especially number and intensity of worries, could differentiate high and low anxious children in a normal school sample. Implications of these findings for understanding the role of worry in childhood anxiety are discussed.

Age Factors↗