The roles of quality of life and family and peer support in feelings about transition to adult care in adolescents with gastroenterology, renal, and rheumatology diseases.

PURPOSE: Transition to adult healthcare is a critical time in the lives of adolescents with chronic medical conditions, with clear impacts on health outcomes. Little is known about factors that impact feelings about healthcare transition, including HRQOL, family and peer support, and utilization of a framework such as the SMART Model can guide exploration of these factors. The goal of this study is to examine how HRQOL (i.e., functional impact of disease) and family and peer support may impact adolescents' feelings about healthcare transition. DESIGN AND METHODS: 135 adolescents (17-23 years) with chronic gastroenterology, renal, or rheumatology disease completed four questionnaires as part of a larger study examining health, relationships, and healthcare transition. Questions assessed current HRQOL (i.e., number of days health was "not good"), peer and family support, and feelings about transition. Data were analyzed using SPSSv25 and linear regressions were performed. RESULTS: Lower HRQOL (ß = 0.283, p < .01) and less peer support (ß = -0.198, p < .05) were associated with worse feelings about transition (R2 = 0.203, p < .001). Family support was significantly correlated at the bivariate level. There were no differences by type of disease, race/ethnicity, or gender that impacted study findings. CONCLUSION(S): Results are concerning as healthcare transition is a milestone for every patient. Lower HRQOL (i.e., greater functional impact of disease) and less peer support were associated with worse feelings about transition. PRACTICE IMPLICATIONS: This study highlights potential targets for intervention such as improving HRQOL (e.g., acceptance and commitment therapy) and increasing peer support (e.g., social skills training, family facilitation) to improve transition to adult care for pediatric patients with chronic diseases.

The Utility of Self-Determination Theory in Predicting Transition Readiness in Adolescents With Special Healthcare Needs.

PURPOSE: Adolescents and young adults with chronic health conditions must learn skills to successfully manage their health as they prepare to transition into adult-based care. Self-determination theory (SDT), an empirically based theory of human motivation, posits that competence (feeling effective), autonomy (volition to perform behaviors), and relatedness (support for autonomy from others) influence behavioral change. This study evaluates the utility of SDT constructs in predicting transition readiness among adolescents and young adults recruited into an intervention to promote successful healthcare transition. METHODS: Baseline assessments were completed by 137 patients aged 17-23 years recruited from pediatric renal, gastroenterology, or rheumatology clinical services. Surveys measured transition readiness (Transition Readiness Assessment Questionnaire) as well as SDT constructs, including competence (Patient Activation Measure); provider relatedness and parent autonomy support (Health Care Climate Questionnaire); and health care-related autonomy (Treatment Self-Regulation Questionnaire). Relationships between SDT constructs and transition readiness were evaluated using linear regression. RESULTS: Between 44 and 48 participants were recruited from each service. Bivariate correlation coefficients between transition readiness and SDT constructs were competence (r = .44), autonomous autonomy (r = .34), controlled autonomy (r = .27), provider relatedness (r = .46), and parental autonomy support (r = .35) (p < .01). Age positively correlated with transition readiness (r = .47, p < .001). After controlling for age, gender, and clinical service, competence (p < .001) and provider relatedness (p = .008) successfully predicted transition readiness (R2 = .423; F change; p < .001). CONCLUSIONS: Findings from this cross-sectional study support the utility of SDT constructs in promoting transition readiness among adolescents and young adults with chronic conditions, underscoring the importance of building competence and provider support for autonomy during this critical period.

The Development of Health Self-Management Among Adolescents With Chronic Conditions: An Application of Self-Determination Theory.

PURPOSE: The purpose of the study was to better understand the progressive development of health self-management among adolescents and emerging adults (AEAs) with chronic medical conditions in order to identify opportunities to prepare AEA for transition to adult-based care. METHODS: Twenty-three AEA aged 17-20 years with renal, inflammatory bowel, or rheumatologic diseases, and their parents, completed individual semistructured interviews describing each AEA's health self-management. Self-Determination Theory was used to frame interview questions, including the constructs of competence, autonomy, and autonomy support. Transcripts were analyzed using directed content analysis. RESULTS: Four themes emerged: Development of Competence in Self-Management; Autonomy: Motivations to Self-Manage; Ways Important Others Support or Hinder Independence; and Normal Adolescent Development. AEA's competency and autonomy increased as they progressed from lack of knowledge about self-management to having knowledge without doing tasks, and, ultimately, to independent completion of tasks. Motivations to self-manage included avoiding sickness/weakness and wanting to engage in activities. Parents and providers supported AEA's autonomy through teaching and transferring responsibility. Parental fear/lack of trust in AEA's ability to self-manage hindered development of AEA's autonomy, producing anxiety. Normal adolescent development impacted timing of self-management task mastery. CONCLUSIONS: As AEA gain competence in increasingly complex self-management tasks, they assume greater responsibility for managing their health. Competence and autonomy are facilitated by a feedback loop: AEA successful self-management increased parent trust, enabling the parent to transfer responsibility for more complex tasks. Conversely, parents' fear of the AEA doing wrong hinders transfer of responsibility, limiting competence and autonomy. Health-care providers play an important role in fostering autonomy.

In-Depth Interviews to Assess the Relevancy and Fit of a Peer-Mentored Intervention for Transition-Age Youth with Chronic Medical Conditions.

STUDY PURPOSE: The purpose of this study is to evaluate the relevancy and fit of a proposed group-based, peer-mentored intervention, based on the principles of Self-Determination Theory (SDT), to facilitate the development of health self-management skills needed to transition from pediatric to adult-based healthcare. DESIGN AND METHODS: Individual in-depth interviews with 28 transition-age youth (TAY) ages 17-22 and 24 caregivers (parents) from Gastroenterology, Renal and Rheumatology clinical services assessed interests in and preferred content, timing of and format for an intervention to help youth build self-management skills. Descriptive statistics were used for short answer questions and rating scales. Thematic analysis was used to analyze transcripts. RESULTS: >90% of TAY and all caregivers thought the proposed group-based transition skills-building intervention was a good idea. TAY expressed wanting someone with lived experience to lead it and a desire to meet other youth with chronic conditions. All caregivers would want their TAY to participate if given the opportunity. Both TAY and caregivers voiced the importance of mental health topics as many TAY experienced anxiety or depression over managing their illness. Nearly 50% of TAY and caregivers thought parents should attend some or all group sessions, though TAY and caregivers within the same family did not always agree. CONCLUSIONS: Findings establish the relevancy and fit of a peer-mentored intervention focused on skill development to successfully transition to adult healthcare. PRACTICE IMPLICATIONS: The group intervention designed using a SDT framework may be particularly relevant as autonomy, competence, and relatedness undergo major developmental changes during adolescence.

Development of a Group-Based, Peer-Mentor Intervention to Promote Disease Self-Management Skills Among Youth With Chronic Medical Conditions.

STUDY PURPOSE: The purpose of this paper is to describe the development of a group-based peer-mentor intervention to enhance knowledge/skills of transition-age youth (TAY) from three clinical services (gastroenterology, renal or rheumatology) at a large children's hospital in order to facilitate transition from pediatric to adult healthcare. DESIGN AND METHODS: Using a multi-modal, iterative approach, the structure/content of the intervention was based on peer-reviewed literature; surveys/interviews conducted with TAY, families, and adult and pediatric providers; principles of Self-Determination Theory and motivational interviewing; and guided by a logic model. A TAY community advisory board helped interpret the information and develop the intervention. RESULTS: The resulting intervention has eight sessions led by peer mentors (young adults who have successfully transitioned to adult healthcare, who are trained to use a motivational interviewing approach) covering topics such as goal setting; understanding my diagnosis; organizing personal, health & insurance information; characteristics of a good provider; filling/refilling prescriptions; and mental well-being. The TAY community advisory board recommended holding two sessions on each of four Saturdays, using interactive group activities to make it fun, and creating a written complimentary manual for caregivers. CONCLUSIONS: A TAY community advisory board was instrumental in developing an innovative peer-mentor intervention to promote the development of specific skills TAY require to manage their disease within adult healthcare. PRACTICE IMPLICATIONS: Although the intervention was developed with extensive stakeholder input, a next step is to evaluate the intervention with respect to how well it fits the broader membership in the target population.

A Multisite 2-Year Follow Up of Psychopathology Prevalence, Predictors, and Correlates Among Adolescents Who Did or Did Not Undergo Weight Loss Surgery.

PURPOSE: We aimed to characterize prevalence, change, predictors, and correlates of psychopathology and associations with weight loss in adolescents with severe obesity 24 months after weight loss surgery (WLS) utilizing a controlled multisite sample design. METHODS: Adolescents undergoing WLS (n = 139) and nonsurgical comparisons with severe obesity (NSComp; n = 83) completed validated questionnaires assessing psychopathology and potential predictors and correlates at presurgery/baseline and 24 months postoperatively/follow-up. RESULTS: At 24 months, 34.7% of WLS and 37.7% of nonsurgical comparisons were categorized as "symptomatic" (Youth Self-Report ≥ borderline on at least one DSM scale). The majority maintained their symptomatic or nonsymptomatic status from baseline to 24 months postbaseline. Remission of symptoms was more common than the development of new symptomatology at 24 months. Beyond demographics, separate models of baseline predictors and concurrent correlates of 24-month psychopathology identified baseline psychopathology and loss of control (LOC) eating as significant. Alcohol use disorder (AUD) and LOC eating emerged as correlates in the concurrent model. For the WLS group, preoperative, postoperative, and change in symptomatology were not related to 24-month percent weight loss. CONCLUSIONS: At 2 years, approximately one in three adolescents were symptomatic with psychopathology. Maintenance of symptomatic/nonsymptomatic status over time or remission was more common than new incidence. Although symptomatology was not predictive of surgical weight loss outcomes at 2 years, preoperative psychopathology and several other predictors (LOC eating) and correlates (LOC eating, AUD) emerged as signals for persistent mental health risks, underscoring the importance of pre- and postoperative psychosocial monitoring and the availability of adjunctive intervention resources.

Peer Victimization in Adolescents With Severe Obesity: The Roles of Self-Worth and Social Support in Associations With Psychosocial Adjustment.

Objective: To examine the associations of peer victimization with internalizing symptoms, externalizing symptoms, social competence, and academic performance in a clinical sample of adolescents with severe obesity, and whether self-worth and social support affect these associations. Methods: Multisite cross-sectional data from 139 adolescents before weight loss surgery ( M age = 16.9; 79.9% female, 66.2% White; M Body Mass Index [BMI] = 51.5 kg/m 2 ) and 83 nonsurgical comparisons ( M age = 16.1; 81.9% female, 54.2% White; M BMI = 46.9 kg/m 2 ) were collected using self-reports with standardized measures. Results: As a group, participants did not report high levels of victimization. Self-worth mediated the effects of victimization on a majority of measures of adjustment, and further analyses provided evidence of the buffering effect of social support for some mediational models. Conclusions: Self-worth and social support are important targets for prevention and intervention for both victimization and poor adjustment in adolescent severe obesity.

Comprehensive obesity evaluation and treatment of three adolescents: a case series.

BACKGROUND: Adolescent obesity is a chronic disease that is impacted from each patient's biopsychosocial milieu. Successfully treating pediatric obesity requires long-term, innovative, systematic involvement to facilitate patient and family engagement and change. METHODS: Extensive chart review was done for three obese adolescents who underwent comprehensive weight management in an adolescent clinic seen within the past 5 years. The charts were reviewed starting from the time of initial contact through the last visit in the clinic. The patients are no longer receiving care within the clinic. RESULTS: The patients presented with BMI>99th percentile, family history of obesity, severe psychosocial stressors, and multiple obesity-related comorbidities. Their treatment involved comprehensive multidisciplinary intervention in an adolescent weight management clinic within a tertiary care center. In addition to rigorous support through frequent office visits, these patients all eventually required temporary, alternative living arrangements to successfully implement recommendations. One patient resided with another family member; two went to inpatient weight management program care for 2-3 months. All subjects successfully lost weight when away from their primary residence, and they demonstrated improvement or resolution of comorbidities. CONCLUSIONS: This case series of three adolescents who underwent comprehensive obesity evaluation and treatment demonstrates multidisciplinary care across interconnected treatment programs and active engagement of family. Those who maintained successful weight loss reduced sedentary time, demonstrated family support (e.g., key members attending follow-up visits), and altered their living environment and were committed to their own health goals.

A qualitative study of the day-to-day lives of obese Mexican-American adolescent females.

OBJECTIVE: In an effort to develop more effective weight-loss interventions, this study examined the daily experiences and personal struggles of Mexican-American adolescent females with morbid obesity. METHODS: Twenty self-identified, morbidly obese Mexican-American adolescent females and their families were interviewed about their food choices, personal and family barriers to weight loss, sources of support, previous weight-loss experience, and weight-related beliefs. Qualitative responses were coded by using framework analysis. RESULTS: Four themes emerged from the adolescent and family responses: the impact of normal adolescent development, multiple sources of excess calories, the physical and emotional burden of excess weight for the adolescent, and the magnitude of the family's personal struggle with weight management. Multiple subthemes were also identified. CONCLUSIONS: Responses by the adolescents and their families highlighted the intersection of adolescence and Mexican-American culture and the daily challenges of obesity. Recommendations for providers include incorporating knowledge of adolescent development and culturally sensitive care into treatment recommendations.

The utility of home problem pervasiveness and severity in classifying children identified with attention-deficit/hyperactivity disorder.

Given the propensity for clinical assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) to focus on core behavioral symptoms, the current study examined how well other predictors classified children who were diagnosed with ADHD by licensed practitioners. Participants were 91 children (39 ADHD-identified, 52 without ADHD), aged 8 to 13 years. In addition to significantly more ADHD symptoms, the ADHD-identified group exhibited significantly more externalizing problems and internalizing symptoms, less adaptive functioning, and greater problem pervasiveness and severity. Binary logistic regression analyses indicated that problem pervasiveness and severity significantly predicted diagnostic group membership when controlling for other predictors, and pervasiveness added unique variance beyond measures of core ADHD symptoms. Diagnostic utility analyses showed measurement of problem pervasiveness and severity to be a useful tool in the identification of ADHD. Findings provide support for the practical use of a parent-report measure of impairment in the home as part of evidence-based assessment of ADHD.

Brief behavioral intervention for young children with disruptive behaviors.

Parent reported behavioral difficulties in young children are relatively common. Without adequate intervention, some children will later present with more severe problem behaviors. Parent management training is one of the best methods of treatment for behavior problems; however, existing treatments can be lengthy and difficult to conduct outside of a research setting. The Brief Behavioral Intervention was designed as a briefer version of a manualized parent management training treatment package. Thirty-one parents of children aged 2-6.5 presenting with behavior problems were included in this initial study of treatment effectiveness. Based on parent and teacher report, treatment was effective in a mean of 7.2 sessions.

A comparison of Latino and Anglo socially desirable responding.

Previous research suggests that Latinos tend to score higher than Anglos on psychometric indicators of socially desirable responding. The purpose of the current study was to test several methodological and cultural explanations for these group differences. Hypothesized explanations included varying levels of problems in living, measurement bias, differential structure of socially desirable responding measures, reliabilities of response style indicators, or cultural factors. Results supported previous findings that self-identified Latino (N=143) respondents score significantly higher than Anglos (N=93) on some socially desirable responding indicators. Groups did not differ in levels of psychopathology and socially desirable responding indicators demonstrated structural similarity, equivalent relations to external criteria, and equivalent reliabilities across groups. Thus, data suggest normative differences between these groups in social presentation that should be considered in culturally sensitive clinical practice.

Relations between the Test of Variables of Attention (TOVA) and the Children's Memory Scale (CMS).

OBJECTIVE: There is considerable overlap in the constructs of attention and memory. The objective of this study was to examine the relationship between the Test of Variables of Attention (TOVA), a measure of attention, to components of memory and learning as measured by the Children's Memory Scale (CMS). METHOD: Participants (N = 105) were consecutive referrals to an out-patient facility, generally for learning or behavior problems, who were administered both the TOVA and the CMS. RESULTS: Significant correlations were found between the omissions score on the TOVA and subscales of the CMS. TOVA variability and TOVA reaction time correlated significantly with subscales of the CMS as well. TOVA commission errors did not correlate significantly with any CMS Index. CONCLUSION: Although significant, the correlation coefficients indicate that the CMS and TOVA are measuring either different constructs or similar constructs but in different ways. As such, both measures may be useful in distinguishing memory from attention problems.