The impact of COVID-19 on adolescents with eating disorders: Increased need for medical stabilization and decreased access to care.

OBJECTIVE: We aimed to identify trends of patients with eating disorders (EDs) requiring hospitalization before and during the pandemic at a children's hospital in the southeastern United States. METHOD: A retrospective chart review was completed for 71 adolescents and young adults (ages 10-21 years; M = 14.61, SD = 2.121). RESULTS: Results indicated a 188% increase in ED hospital admissions since the pandemic, with patients presenting with increased rates of comorbid mental health diagnoses (p = .009). During COVID-19, the development of temporary outpatient multidisciplinary discharge plans (i.e., "bridge plans") were utilized more often due to difficulties accessing the appropriate level of care (p = .039). DISCUSSION: Results suggest a significant increase in youth requiring medical stabilization for EDs since the start of the COVID-19 pandemic (2.9 times more than prepandemic), as well as a need for greater advocacy to increase specialized mental health services along the full continuum of care. PUBLIC SIGNIFICANCE STATEMENT: This study brings awareness to the significant increase in patients needing medical stabilization secondary to restrictive EDs and increased rates of comorbid mental health diagnoses in this patient population since the onset of the COVID-19 pandemic. Patients during COVID-19 were less likely to directly transition to treatment likely secondary to the strain COVID-19 placed on mental health systems/treatment centers. Increased advocacy for specialized care for eating disorder patients.

Relationships Among Parenting Stress and Well-Being, COVID-19 Information Management, and Children's COVID-19 Fear.

OBJECTIVE: During the COVID-19 pandemic, caregivers who are facing high stress levels and decreased emotional well-being may parent their children differently. Certain children are experiencing greater fear in response to COVID-19, and research is needed to identify parenting behaviors significantly linked with children's COVID-19 fear. The purpose of this article was to evaluate whether the association between parenting stress and children's COVID-19 fear could be explained by parents' COVID-19 information management and emotional well-being. METHODS: Participants were recruited through Amazon Mechanical Turk. The sample consisted of 595 caregivers of children during the COVID-19 pandemic; 40.0% men, 69.2% non-Latinx White, 12.1% Black, 10.1% Latinx, 6.6% Asian, and <2% others. Children had an average age of 11.3 years. Parents completed self-report measures. RESULTS: The bootstrapped confidence interval (0.040, 0.148) for the indirect effect (0.090) revealed that parent emotional well-being significantly mediated the relation between parenting stress and children's COVID-19 fear. In addition, parent management of children's COVID-19 knowledge significantly mediated the relation between parenting stress and children's COVID-19 fear. CONCLUSION: We found that the combined effect of parents' emotional well-being and parents' management of children's COVID-19 knowledge significantly mediated the positive relation between parenting stress and children's COVID-19 fear. Based on our findings, once parents' parenting stress is decreased and their well-being increases, parents may be more likely to provide children with developmentally appropriate and accurate COVID-19 information.

Social self-efficacy associated with HbA1c through physical activity and diabetes quality of life: A serial mediation study.

OBJECTIVE: Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses and increasing worldwide in prevalence. Physical activity has been positively linked with better glycemic control in youth with T1D. Although not yet studied, children's social self-efficacy may be a parameter related to physical activity in youth with diabetes. The current study investigated associations among social self-efficacy, physical activity, diabetes quality of life, and hemoglobin A1c (HbA1c) among youth with T1D utilizing mediation and serial mediation models. RESEARCH DESIGN AND METHODS: Participants were 144 youth (M age = 14.95) with T1D (53.5% girls) and their caregivers. Youth completed the PedsQL Diabetes Module, the Physical Activity Questionnaire for Older Children and Adolescents and the Self-Efficacy Questionnaire for Social Skills for Children. Youths' HbA1c values were also measured. RESULTS: Physical activity significantly mediated the relationship between greater youth social self-efficacy and better diabetes quality of life. Diabetes quality of life mediated the relationship between greater physical activity and lower HbA1c. The serial mediation model demonstrated greater social self-efficacy is related to greater physical activity, which in turn is related to better diabetes quality of life and ultimately resulting in lower HbA1c. CONCLUSIONS: Physical activity, social self-efficacy, and diabetes-related quality of life may be modifiable factors related to HbA1c for youth with T1D. Findings indicate a need for healthcare providers to consider youth physical activity, quality of life, and social self-efficacy when evaluating and intervening in youth diabetes treatment adherence.

Youth safety perceptions of weight control behaviors: A moderated mediation study.

BACKGROUND: Youth may engage in healthy weight control behaviors (HWCBs) and unhealthy weight control behaviors (UWCBs) to lose or maintain weight. Youth observation of WCBs by supporter groups (parents/siblings/peers) and youth beliefs about the safety of WCBs may impact which WCBs youth use. The primary aim of this study was to examine the mediating role of youth safety perceptions of WCBs on the relationships between supporter group engagement in WCBs and youth engagement in WCBs. Youth BMI-z-score was analyzed as a moderator. METHODS: Participants were 219 youth (52.1% females), ages 10-17, attending an outpatient medical appointment. Participants completed questionnaires about their WCB use, whether they perceived WCBs as safe/unsafe, and whether they perceived parents, siblings and peers to use WCBs. A standardized formula including youth age, sex, height, and weight was used to calculate BMI-z-score. RESULTS: A moderated mediation model examining parental and youth engagement in UWCBs revealed that for youth in the healthy to overweight/obese (OV/OB) range, greater safety perception of UWCBs mediated the relationship between higher parent engagement in UWCBs and higher youth engagement in UWCBs. Furthermore, youth safety perception of HWCBs mediated the relationship between perceived parent, sibling, and peer engagement in HWCBs and youth engagement in HWCBs. CONCLUSION: This study identifies perceived parent, sibling, and peer WCBs and youth safety perceptions as mechanisms affecting youth WCB engagement, particularly for youth in the OV/OB range. Intervention effectiveness may increase if parent, sibling, and peer WCBs are targeted and education about safe/unsafe ways to control weight is provided.

Quantifying the psychosocial impact of a weekend retreat on adolescent and young adult (AYA) oncology patients.

OBJECTIVE: This study aimed to determine if AYA oncology patients experienced a quantifiable improvement in psychosocial outcomes after attending a weekend retreat with their peers. METHODS: AYA oncology patients attended a weekend retreat. They completed the Functional Assessment of Cancer Therapy - General (FACT-G) before, 1 month after, and 6 months after the weekend retreat. Controls were age-matched oncology patients who did not attend the retreat. FINDINGS: Retreat participants' scores did not significantly change over time; however, retreat participants' scores at 1-month follow-up were significantly higher than control group scores. CONCLUSIONS: AYA oncology patients may experience transient improvement in psychological well-being after attending a retreat, but benefits may not be durable. Work remains needed to examine the impact of retreat attendance on specific aspects of psychosocial well-being. Implications for psychosocial oncology: Work is needed to decrease perceived attendance barriers for AYA oncology patients who have a low quality of life. Future retreat planners may consider modifying retreat activities and consider alternative retreat locations that appeal to campers with limited mobility, chronic pain, and/or other quality of life limitations. Additional study is needed to determine whether brief overnight or weekend retreats can be as effective as week-long camps in enhancing oncology patients' quality of life. Future researchers should compare changes in weekend retreat attendees' quality of life to changes in quality of life for a control group (e.g., via a waitlist control study design).

Pre-surgical stress and social support predict post-surgical percent excess weight loss in a population of bariatric surgery patients.

Although bariatric surgery is an effective treatment of morbid obesity, many patients fail to lose significant weight or regain weight over time. This study examined pre-surgical psychosocial predictors (stress, social support for healthy eating, emotion regulation, and sleep quality/quantity) of three-month post-surgical percent excess weight loss (EWL) in a population of adult bariatric surgery patients. Overall, findings suggest higher levels of stress (B = -.248, p =.017) and less social support for healthy eating (B =.311, p =.013) predict lower three-month post-surgery percent EWL. Emotion regulation, and sleep measures did not predict post-surgery percent EWL. Therefore, level of stress and social support should be assessed prior to bariatric surgery and considered important pre-surgical intervention targets.

Adolescent-Reported Sleep/Wake Patterns in the Relationships Between Inhibitory Control and Internalizing and Externalizing Problems.

OBJECTIVE: Youth with poorer inhibitory control are more likely to experience internalizing and externalizing problems, placing them at risk for poorer psychological, academic, and social functioning. Modifying inhibitory control is challenging; therefore, research is needed to identify alternative targets to reduce internalizing and externalizing problems in youth. Sleep/wake patterns may serve as alternative targets, given their relationships with poorer inhibitory control and greater internalizing and externalizing problems. This study examines the mediating role of sleep/wake patterns in the relationships between youth inhibitory control and internalizing and externalizing problems. METHOD: One hundred fifty-five adolescent (ages 12-15 years) and parent dyads completed the Behavioral Rating Inventory of Executive Function, Pediatric Symptom Checklist, and Adolescent Sleep-Wake Scale, short version. Bootstrapped mediations examined indirect relationships between inhibitory control and internalizing and externalizing through sleep/wake patterns. RESULTS: Analyses revealed that problematic sleep/wake patterns partially mediated the relationship between poorer inhibitory control and greater internalizing, explaining 19% of the variance in internalizing problems. In addition, problematic sleep/wake patterns partially mediated the relationship between poorer inhibitory control and greater externalizing, explaining 58% of the variance in externalizing problems. CONCLUSION: The results suggest that sleep/wake patterns may be a mechanism through which deficits in inhibitory control increase youth risk for internalizing and externalizing problems. Because sleep/wake patterns are frequently modified through adoption of health behaviors conducive to good sleep, assessing for problematic patterns in adolescents who present with internalizing and externalizing problems may offer providers a relatively modifiable target to reduce the emotional and behavioral problems of youth with poorer inhibitory control abilities.

Family functioning mediates the relationship between child behavior problems and parent feeding practices in youth with overweight or obesity.

Parental feeding practices play a significant role in children's health behaviors. Given the high prevalence of childhood obesity, it is important to examine factors that may influence parental feeding practices. This study examined the role of family functioning on the relationship between child behavior problems and parent feeding practices. We hypothesized that higher problematic child behavior would correlate with lower parental engagement in healthy parent feeding practices, with greater family dysfunction mediating that relationship. Participants (n = 220) were rural-dwelling parents of school-aged children with overweight or obesity. Participants completed the McMaster Family Assessment Device, Child Behavior Checklist (CBCL), and Child Feeding Questionnaire at baseline. Mediation models were used with youth behavioral problems (CBCL) as the independent variable, parental feeding practices as the dependent variable, and family functioning as the mediator. Two significant mediation models revealed (a) family functioning mediated the relationship between child behavior problems and parental perception of responsibility taking for child eating, and (b) family functioning mediated the relationship between child behavior problems and parental monitoring of their child's eating. More child behavior problems were associated with unhealthier family functioning, which was associated with less parental monitoring of children's unhealthy food intake and reduced responsibility taking for feeding and meal planning of their children. These findings suggest the synergistic effect of child behavior problems with poorer family functioning may be a risk factor for unhealthy parent feeding practices in children with overweight or obesity. If these relationships are supported by longitudinal research, behavior interventions for children with obesity should consider poor family functioning and child behavior as potential barriers to parental monitoring and responsibility of children's feeding practices.

Parents' emotion socialization beliefs moderate relations between parent and patient coping, but not sibling coping, with pediatric cancer.

OBJECTIVE: This study evaluated (a) differences in parents' emotion socialization (ES) beliefs for patients/siblings, (b) whether parents' ES beliefs predict patient/sibling coping, and (c) whether parents' ES beliefs moderate links between parent and patient/sibling coping with pediatric cancer. METHOD: This was a cross-sectional, questionnaire-based study of 134 pediatric cancer patients, their caregiver, and their nearest-age sibling. Participants could complete measures themselves via paper-and-pencil or telephone, or researchers could read questions aloud. RESULTS: Parents' ES beliefs differed for patients/siblings. ES beliefs did not directly predict patient/sibling coping but did moderate relations between parent and patient coping. CONCLUSIONS: Despite extent literature promoting universal emotion coaching ES, our study indicates that ES beliefs might have a complex relation with parent coping in predicting patient coping.

Parent perceptions of restrictive feeding on the relationship between youth BMI z-score and weight control behavior use in African American youth: A mediational study.

BACKGROUND: Children with higher body weights engage in more healthy weight control behaviors (HWCBs) and unhealthy weight control behaviors (UWCBs) compared to healthy weight peers. Parent restrictive feeding (parental attempts to limit what and how much children eat in an effort to manage youth weight) has also been associated with youth weight. However, there is limited research on parental feeding practices among non-Caucasian samples, despite evidence that parental feeding may function differently across races. Therefore, the current study aimed to examine the mediating role of parent restrictive feeding on the relationship between youth body mass index (BMI) z-score and youth use of HWCBs and UWCBs among African American youth. METHODS: Measures were completed by youth (ages 10-13 years) and their parents at a pediatric primary-care appointment. Youth completed a weight control behavior questionnaire asking youth to answer whether or not they have engaged in specific behaviors to lose weight. Parents completed a questionnaire on parent-feeding practices. Youth height and weight were obtained from their medical records. RESULTS: Mediation models revealed parent restrictive feeding significantly mediated the relationship between youth BMI z-score and HWCB use, but not between youth BMI z-score and UWCB use. CONCLUSION: Results from the current study suggest parent restrictive feeding in African American populations may encourage health promoting youth weight management behaviors. Additional research is warranted to investigate how cultural factors may impact the relationships between parent restrictive feeding practices and youth weight control behaviors as there may be important clinical implications when working with diverse populations.

The Role of Child and Adolescent Adjustment Problems and Sleep Disturbance in Parent Psychological Distress.

The goal of this study was to examine the moderating role of youth sleep disturbance on the relationship between youth internalizing and externalizing symptoms and parent psychological distress. Participants were 225 youth (ages 8-17) and parent dyads attending a primary care clinic appointment. Participants completed questionnaires that assessed parent psychological distress, youth internalizing symptoms, youth externalizing symptoms, and youth sleep disturbance. Moderation analyses were conducted to examine whether youth sleep disturbance moderated the relationship between youth internalizing and externalizing symptoms and parent psychological distress. The interaction between youth internalizing symptoms and youth sleep disturbance was significantly related to parent psychological distress, such that having increased sleep disturbance amplified the positive relationship between internalizing symptoms and parent psychological distress. The moderation model explained 52% of the variance in parent psychological distress. The interaction between youth externalizing symptoms and youth sleep disturbance was also significantly related to parent psychological distress, such that increased sleep disturbance amplified the positive relationship between externalizing symptoms and parent psychological distress. This model accounted for 53% of the variance in parent psychological distress. Greater youth sleep disturbance strengthens the positive relationship between youth internalizing/externalizing symptoms and parent psychological distress. Accordingly, reducing youth sleep disturbance may serve as an appropriate intervention target in families experiencing increased parent psychological distress.

Psychometric properties of the Kids' Child Feeding Questionnaire-Restriction.

BACKGROUND: Research exploring parental restrictive feeding is mixed and shows that it both negatively and positively affects children's dietary intake. One hypothesis for these inconsistent findings is the use of parent-report vs. youth-report measures of parental restrictive feeding, but there are limited psychometrically-sound youth-report measures of this construct. Therefore, the current study aims to evaluate the psychometric properties of a measure of parent restrictive feeding practices, the Kids' Child Feeding Questionnaire-Restriction (KCFQ-R), from the youth perspective. METHODS: The 7-item, youth-report KCFQ-R is composed of the restriction subscale from the Kids' Child Feeding Questionnaire. This measure was completed by 225 youth attending a primary care appointment. RESULTS: Initial exploratory factor analysis and communalities yielded a single factor solution explaining 39.93% of the variability in the data. Internal consistency using the seven items was .73. The KCFQ-R demonstrated external validity through its significant relationship with parent concern about child overweight. CONCLUSIONS: Results provide preliminary support that the KCFQ-R is a psychometrically sound and reliable measure of youth-reported parental restrictive feeding practices. Given the mixed research on the effects of parent-reported parental feeding restriction on various child outcomes, this youth-report measure may help clarify these relationships. Future research should examine youth-report measures of other parent feeding domains.

The Moderating Role of Body Dissatisfaction in the Relationship between ADHD Symptoms and Disordered Eating in Pediatric Overweight and Obesity.

BACKGROUND: Identifying factors linked to disordered eating in overweight and obesity (OV/OB) may provide a better understanding of youth at risk for disordered eating. This project examined whether ADHD symptoms and body dissatisfaction were associated with disordered eating. METHODS: ADHD symptoms, disordered eating, and body dissatisfaction were assessed in 220 youth ages 7-12 who were OV/OB. RESULTS: Multiple linear regressions showed that body dissatisfaction and ADHD symptoms were associated with disordered eating. DISCUSSION: Children with ADHD symptoms and OV/OB may be at greater risk for disordered eating when highly dissatisfied with their bodies. Healthcare providers should assess body image and disordered eating in youth with comorbid OV/OB and ADHD.

Youth Safety Perceptions of Weight Control Behaviors.

OBJECTIVE: Youth attempting to lose weight may engage in a variety of weight control behaviors (WCBs), some of which are viewed as healthy WCBs (HWCBs), whereas others are viewed as unhealthy WCBs (UWCBs). This study sought to examine youth perceptions of which WCBs are safe versus unsafe ways to lose weight. Furthermore, youth safety perceptions of WCBs and body mass index (BMI) z-scores were examined in relation to how often youth engage in these WCBs. METHOD: Participants were 219 youth (aged 10-17 years) attending a primary care clinic appointment. Participants completed questionnaires about the frequency of their own WCB use and whether they perceived each WCB as a safe way to lose weight. RESULTS: Results revealed differences in safety perceptions across weight status groups for certain HWCBs and UWCBs. Youth perception of WCBs as safe ways to lose weight was associated with more frequent engagement in WCBs. Furthermore, an interaction between youth safety perception of HWCBs and youth BMI z-scores was related to greater engagement in HWCBs, such that the relationship between safety perception and engagement was only significant for youth who are overweight/obese. The moderation model explained 36.95% of the variance in engagement in HWCBs. The moderation model was also significant for UWCBs (r = .35). CONCLUSION: This study identifies youth safety perception of WCBs as a mechanism that may lead to increased youth engagement in WCBs. Health care providers should educate both youth and family members about safe versus unsafe WCBs.

Diaphragmatic breathing and its effectiveness for the management of motion sickness.

BACKGROUND: Motion sickness is an unpleasant physiological state that may be controlled via nonpharmacological methods. Controlled breathing has been shown to maximize parasympathetic nervous system (PNS) tone and may have the ability to decrease motion sickness symptoms. METHODS: The effects of slow diaphragmatic breathing (DB) in a motion sickness-inducing environment were examined within motion sickness susceptible individuals. Subjects (N = 43) were assigned randomly to either an experimental group trained in slow DB or a control group breathing naturally at a normal pace. The experimental group was trained using a digital video that helped them pace their diaphragmatic breathing at six breaths/min. During the study, subjects viewed a virtual reality (VR) experience of a boat in rough seas for 10 min. Motion sickness ratings along with heart rate and respiration rate were collected before, during, and after the VR experience. RESULTS: Results indicated that the experimental group was able to decrease their breathing to eight breaths/min during the VR experience. This breathing rate was significantly slower than those in the control group. We found that DB subjects, compared to those in the control group, displayed significantly greater heart rate variability and reported feeling less motion sickness during exposure to the VR experience than those in the control group. DISCUSSION: Results indicate possible benefits of using slow DB techniques in a motion sickness inducing environment.

Use of controlled diaphragmatic breathing for the management of motion sickness in a virtual reality environment.

Evidence indicates that activation of the parasympathetic nervous system (PNS) suppresses physiological responses associated with motion sickness. Research also shows paced breathing increases PNS activation; the current study examines the use of paced diaphragmatic breathing (DB) training to quell motion sickness symptoms. Healthy participants (N = 60) were pre-screened for motion sickness susceptibility. Participants were then randomly assigned to either a control condition, focusing on environmental awareness, or to an experimental condition implementing paced DB. Following this, participants were exposed to a virtual reality (VR) motion sickness experience, while heart rate variability, breathing rate (RPM), and motion sickness ratings were collected. Results demonstrated participants in the DB condition had higher PNS activation and reported fewer motion sickness symptoms during the VR experience than the participants in the control condition. Results suggest that the DB protocol can be used to significantly increase PNS tone and decrease the development of motion sickness symptoms.

A national survey of candidates: II: motivations, obstacles, and ideas on increasing interest in psychoanalytic training.

A national survey of candidates was conducted to identify motivations for pursuing psychoanalytic training, obstacles that prevent progression or completion, and candidates' ideas on how best to increase interest among potential trainees. In 2009-2010, 40 percent of candidates on the affiliate member e-mail list completed an anonymous web-based survey. Candidates strongly endorsed contact with a personal psychotherapist, psychoanalyst, or supervisor as the most important influence in discovering psychoanalysis and deciding to pursue training. They identified the total cost of analytic training as the greatest obstacle. This was followed by the cost of personal analysis, loss of income for low-fee cases, time away from family, and difficulty finding cases. To enhance training, local institutes should work to improve institute atmosphere and provide assistance with finding cases; national organizations should increase outreach activities and publicize psychoanalysis. Psychoanalytic institutes could recruit future candidates by working to increase personal contact with psychoanalysts, reducing the cost of training, improving institute atmosphere, assisting with case-finding, enhancing outreach activities, and widely publicizing psychoanalysis. Narrative comments from candidates and the implications of these findings regarding engagement of future trainees are discussed.

A national survey of candidates: I. demographics, practice patterns, and satisfaction with training.

To better focus efforts in recruiting psychoanalytic candidates, current candidates' demographics, practice patterns, and satisfaction with psychoanalytic training were investigated. An anonymous web-based survey was distributed by e-mail to all candidates subscribing to the affiliate member e-mail list in 2009-2010. Surveys were completed by 226 of 565 affiliate members, for a return rate of 40%. The majority of respondents were women 45 to 64 years of age, married, with a doctoral degree, in private practice, with an annual household income of over $100,000. Most candidates devoted 11 to 30 hours a week to training and had no analysts or candidates in their workplace. Almost half had considered training for more than four years before matriculation, with financial issues cited most frequently as delaying entry. Over 80% of respondents were satisfied with their training. The most frequently cited reasons for dissatisfaction were a negative institute atmosphere, concerns about teaching or the curriculum, and difficulty finding cases. Candidates in training for eight years or more accounted for almost 20% of the group and were more often dissatisfied with training. This study demonstrates that the majority of current candidates are satisfied with training but suggests that recruitment may become increasingly difficult unless factors related to time, cost, case finding, graduation requirements, and institute atmosphere can be addressed.