Identifying Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach.

OBJECTIVES: Youth with sickle cell disease (SCD) and chronic pain, defined in this study as pain on most days for 3 months, experience variability in daily pain and physical and psychosocial functioning. This study aimed to (1) empirically derive chronic pain subgroups based on pain characteristics among youth with chronic SCD pain; and (2) investigate derived subgroups for differences in sociodemographics, clinical characteristics, and psychosocial and functional outcomes. MATERIALS AND METHODS: Youth with chronic SCD pain (n=62, Mage =13.9, SD=2.5, 10 to 18 y; 58% female, 60% HbSS) completed a battery of questionnaires. Clinical characteristics (eg, medications, treatments) and health care utilization were abstracted from electronic medical records. Hierarchical cluster analysis informed the number of clusters at the patient level. k-means cluster analysis used multidimensional pain assessment to identify and assign patients to clusters. RESULTS: Cluster 1 (n=35; Moderate Frequency, Moderate Pain) demonstrated significantly lower worst pain intensity, number of pain days per month, number of body sites affected by pain, and pain quality ratings. Cluster 2 (n=27; Almost Daily, High Pain) reported high ratings of worst pain intensity, almost daily to daily pain, greater number of body sites affected by pain, and higher ratings of pain quality (all P 's <0.05). There were no differences between subgroups by sociodemographics, clinical characteristics, or health care utilization. The Almost Daily, High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing than the Moderate Frequency, Moderate Pain subgroup. DISCUSSION: Identifying chronic SCD pain subgroups may inform tailored assessment and intervention to mitigate poor pain and functional outcomes.

The distinct longitudinal impact of pain catastrophizing on pain interference among youth living with sickle cell disease and chronic pain.

Youth living with chronic sickle cell disease (SCD) pain are at risk for psychosocial distress and high levels of pain catastrophizing that contribute to functional impairment. This study aimed to identify the unique long-term impact of pain catastrophizing on pain impairment among youth with SCD. Youth with chronic SCD pain (N = 63, 10-18 years old, 58.3% female, 95.1% Black or African American) were recruited within comprehensive SCD clinics and completed a battery of measures at baseline and 4-months follow-up. A linear hierarchical regression examined baseline demographic and clinical characteristics (child SCD genotype, age, and average pain intensity), psychosocial functioning (anxiety, depression), and pain catastrophizing as predictors of pain interference at 4-months follow-up. Pain catastrophizing was the only unique predictor of pain interference at 4-months follow-up. Among youth with chronic SCD pain, pain catastrophizing warrants greater consideration as an important predictor that influences pain management and overall functioning.

Adverse Childhood Experiences Among Children with Neurodevelopmental Delays: Relations to Diagnoses, Behavioral Health, and Clinical Severity.

Limited research has examined adverse childhood experiences (ACEs) among children at risk for neurodevelopmental delays. The purpose of this study was to (1) identify the prevalence of ACEs among children at risk for neurodevelopmental delays; (2) explore differences in rates of ACEs across neurodevelopmental diagnoses; and (3) examine relations between ACEs and indicators of behavioral health functioning (e.g., enuresis, feeding problems, sleeping problems, and functional impairment). Participants were 193 children ages 2 to 11 who received a developmental and behavioral pediatrics evaluation at a subspecialty clinic. Caregivers completed a survey about their child's ACEs, and researchers conducted an electronic health record review. Overall, 47% experienced at least one ACE. ACEs were not related to neurodevelopmental diagnosis or to externalizing symptoms. ACEs were related to difficulty sleeping, lower hyperactivity, and greater functional impairment at home. The relations between early adversity and poor behavioral health functioning may develop over time, creating an excellent window of opportunity for prevention work.

What Caregivers Want: Preferences for Behavioral Health Screening Implementation Procedures in Pediatric Primary Care.

There has been a national push for universal psychosocial prevention screening in pediatric primary care. Implementation science highlights the importance of considering patients' perspectives when developing such procedures; however, minimal studies have examined this. The present study employed a mixed-methods design to examine caregivers of pediatric patients' (n = 149) preferences and comfort with psychosocial screening procedures. A subset of participants (n = 20) were interviewed to better understand reasons for responses. Results indicated that caregivers rated screening for physical health, development, emotion and behavior, caregiver adverse childhood experiences (ACEs), and child ACEs within primary care as important or very important. The majority of caregivers were not comfortable completing screenings in the waiting room and preferred the exam room. Caregivers primarily preferred the primary care provider to administer screenings and communicate results and recommendations. Parents also preferred the behavioral health provider to provide recommendations on emotion and behavior, parent ACEs, and child ACEs. Qualitative reasons for responses included relationship quality, knowledge of child, expertise, and desire for direct communication. Findings have implications for developing family-centered, trauma-informed practices within primary care, particularly among those within under-resourced rural communities.

Adverse Childhood Experiences and Family Resilience Among Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: The purpose of the present study was to (1) examine the differences in adverse childhood experiences (ACEs) among children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and comorbid ASD/ADHD and healthy neurodevelopmental controls; (2) explore the levels of family resilience across diagnostic categories; (3) identify the differences in family resilience by the number of ACEs; and (4) explore the interaction between ACEs and the diagnostic category on family resilience. METHOD: Participants were 2083 children between the ages of 6 and 17 years (M = 12.23, SD = 3.36) from the 2016 National Survey of Children's Health. The majority of the sample were male (68.7%) and white (78.6%). RESULTS: Overall, youth diagnosed with solely ADHD had the highest number of ACEs (Madj = 1.94). In addition, individuals who endorsed exposure to 1 ACE reported higher levels of family resilience in comparison to those who reported 0 ACEs or 2 or more ACEs. Family resilience did not differ between youth who experienced 2 or more ACEs and youth who experienced 0 ACEs. Youth diagnosed with comorbid ASD/ADHD had the lowest levels of family resilience. Interestingly, family resilience did not differ between ADHD and neurotypical youth. CONCLUSION: Youth diagnosed with ADHD seem to be at the highest risk for ACEs. Those with comorbid ASD/ADHD report the lowest levels of family resilience when controlling for exposure to ACEs. Families of youth with ASD had lower levels of family resilience than those of neurotypical youth when controlling for exposure to ACEs, whereas families of youth with solely ADHD displayed similar levels of family resilience in comparison to neurotypical youth and their families. Results have implications for prevention and intervention with ASD and/or ADHD youth and their families.

Recognizing the hurt: Prevalence and correlates of elevated PTSD symptoms among adolescents receiving mental/behavioral health services in primary care.

Youth are commonly exposed to potentially traumatic events (PTEs). Following exposure, approximately 25% develop persistent mental and behavioral health (M/BH) symptoms, yet many go untreated or are misdiagnosed and suffer adverse outcomes. Primary care is an ideal setting for detection of trauma-related symptoms. The current article uses archival data to (1) examine the prevalence of posttraumatic stress symptoms that are unlikely, possible, and likely to meet diagnostic criteria for posttraumatic stress disorder (PTSD) and the M/BH and physical health concerns that co-occur with PTSD symptoms among adolescents (n = 133, mean age = 15.1 years, 67% female, 60% White) referred for brief, integrated M/BH services within primary care and (2) identify the prevalence of referred adolescents with elevated symptoms of PTSD that would not be identified for services by traditional depression screening. M/BH providers assessed referred patients for PTSD, M/BH, and physical health symptoms as a routine part of services. Fifty-eight percent screened positive for PTSD (PTSD-possible or PTSD-likely range). The subset of adolescents in the PTSD-likely range (29%) reported significantly greater stress, depression, anxiety, anger, and externalizing symptoms than those categorized as PTSD-possible or PTSD-unlikely. Adolescents in the PTSD-possible or PTSD-unlikely ranges did not differ on any M/BH variables; PTSD groups' physical health did not differ. Of note, 15% of adolescents reporting symptoms likely to meet PTSD criteria did not report elevated depressive symptoms and would have been overlooked by depression screening alone. Given the prevalence of PTEs among M/BH patients, trauma-informed care is necessary for quality patient care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Heterogeneity Within Domestic Violence Exposure: Young Adults' Retrospective Experiences.

Using Holden's taxonomy of domestic violence (DV) exposure as a guiding framework, the current study examined young adults' diverse DV exposure experiences. Twenty-five young adults (ages 19-25) exposed to father-perpetrated DV during their childhood and adolescence were interviewed using a qualitative descriptive design. Data analyses focused on coercive control exposure through reports of non-physical abuse tactics, types of exposure (e.g., direct, indirect), physical violence exposure (e.g., severity, frequency), and child abuse and harsh parenting practices. DV-exposed young adults were directly and indirectly exposed to physical violence and an array of non-physical abuse tactics toward their mothers. Young adults categorized as having been exposed to coercive controlling violence reported exposure to ongoing, non-physical abuse tactics and more frequent and severe physical violence. These young adults were also more likely to intervene and become victimized during physical violence and reported repeated episodes of child abuse and harsh parenting. Although coercive control appeared to be associated with physical violence and child abuse, generalizations should be made with caution as a few participants exposed to situational conflict were exposed to frequent and severe DV. The findings suggest that DV exposure should be measured in methodologically sophisticated ways to capture the heterogeneity in experiences, with the goal of promoting empirically driven intervention and prevention initiatives that are tailored to individual and family needs.

Student's Perceptions of School Safety: It Is Not Just About Being Bullied.

This study examined the relationship of students' perceptions of school safety and school avoidance related to feeling unsafe with predictor variables: bullying victimization, student/teacher/parent/administration relations, rule clarity and consistency, school physical environment (negative and positive), and student's belongingness. In a public high school sample ( n = 585), 24.7% of students felt unsafe and 14.4% avoided school due to feeling unsafe during the past month. Being female and experiencing bullying was associated with feeling unsafe. However, after accounting for demographics and bullying victimization, perceptions of safety increased when students reported positive student and teacher relations, consistent rules, a clean school that is also crowded/noisy, and a sense of school belonging. Avoiding school because of safety concerns was related to decreased school belonging and teacher/student relationships, but not bullying. Focusing on enhancing the school climate/environment, facilitating student belongingness, and reducing bullying are ways school nurses can help promote safer schools.