Predictors of psychological adjustment in school-age children infected with HIV.

OBJECTIVE: To assess for significant differences in psychological functioning between HIV-infected children and a demographically matched healthy control group and to examine the utility of applying a stress and coping model to children with HIV disease. METHODS: Participants included HIV-infected children (ages 6-16) and their caregivers (n = 36) and a control group of healthy children and their caregivers (n = 32). During routine clinic visits, children completed measures of psychological adjustment, health locus of control, and coping style, and caregivers completed measures of their own and their child's psychological adjustment. RESULTS: Caregiver-reported and child self-reported psychological adjustment scores did not significantly differ between the HIV and control groups, with the exception of significantly more internalizing behavior problems reported in the control group. Hierarchical multiple regression analyses revealed that the stress and coping model accounted for 36% of the variance in HIV-infected children's self-reported psychological adjustment. In addition, child age and coping style were significant predictors of child self-reported psychological adjustment, but not of caregiver-reported child adjustment. CONCLUSIONS: Approximately 25% of children with HIV disease exhibited clinically significant emotional or behavioral problems; however, even higher rates of psychological adjustment problems were found in healthy children. Children with HIV disease who have not been told their diagnosis and children who endorse more emotion-focused coping strategies tend to exhibit more psychological adjustment problems.

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors.

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.

The Child-Adult Medical Procedure Interaction Scale-Revised: an assessment of validity.

Investigated the validity of the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) using multiple concurrent objective and subjective measures of child distress, approach-avoidance behavior, fear, pain, child cooperation, and parents' perceived ability to help their preschool children during routine immunizations. Parents', staffs', and children's behaviors in the treatment room were videotaped and coded. Results indicate that the validity of the CAMPIS-R codes of Child Coping and Distress, Parent Distress Promoting and Coping Promoting, and Staff Distress Promoting and Coping Promoting behavior were supported, with all significant correlations being in the predicted direction. An unanticipated finding was that the child, parent, and staff Neutral behaviors were inversely related to some measures of distress and positively related to some measures of coping. Interobserver reliability was high for each CAMPIS-R code.

The Behavioral Approach-Avoidance and Distress Scale: an investigation of reliability and validity during painful medical procedures.

Validated the use of the Behavioral Approach-Avoidance and Distress Scale (BAADS; Hubert, Jay, Saltoun, & Hayes, 1988), which was reported to be easily completed and scored in an analog situation, for measuring children's distress and coping style during actual painful medical procedures. 60 preschool children who were receiving immunizations at a health department were subjects. Objective measures (Observational Scale of Behavioral Distress and Child-Adult Medical Procedure Interaction Scale-Revised) and subjective measures (child-, parent-, and nurse-report) were used. Results of the current study support the internal consistency and concurrent validity of the Distress subscale of the BAADS; however, some caution is suggested in interpreting the Approach-Avoidance subscale. Discussion focuses on the utility of this scale in clinical settings and the cost-effectiveness of this measure for assessing pediatric patients.

Factors affecting children's attitudes toward health care and responses to stressful medical procedures.

Assessed factors hypothesized to influence children's and mothers' attitudes toward health care phenomena and children's distress during a stressful medical procedure in a pediatric outpatient clinic. Children, ages 6-11 years, and their mothers attending a county health department for a well-child physical examination participated. Pearson correlation coefficients were calculated and hierarchical regression analyses were conducted. Results indicated that several factors, including age, health locus of control, and maternal health care attitudes were significant predictors and/or correlates of children's attitudes toward health care and their behavioral responses during an aversive procedure. Implications of these findings for health prevention and education efforts with children are discussed.

Helping preschool leukemia patients and their parents cope during injections.

Taught 4 preschool leukemia patients (ages 3-5) to engage in specific coping behaviors before and during painful intramuscular and intravenous injections. Parents were taught to coach their children in the use of the coping behaviors. Intervention was delivered in a multiple baseline across-subjects design. Parent and child behavior was coded using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R, Blount, Powers, & Sturges) and Observation Scale of Behavioral Distress (OSBD, Elliott, Jay, Woody). Parents and nurses rated child behavior as well. Results indicated that parents learned coping-promoting behaviors, children learned specific coping behaviors, and children displayed less behavioral distress. Maintenance of behavior change was addressed. Contributions of this study to the current literature on children's coping with invasive medical procedures and implications for future research and clinical practice are discussed.