Pediatrician's communication style: relationship to parent's perceptions and behaviors.

Investigated physician-parent communication styles and the effects of concordance between parent's desired communication styles and the communication style exhibited by physicians. Subjects were 107 parents of children scheduled for an appointment with a pediatrician at a general medical clinic. Parents and physicians completed rating forms indicating the degree to which parents desired each of four communication styles (information giving, interpersonal sensitivity, partnership, and directing one's own treatment). Parents and physicians also rated the degree to which they believed the physician exhibited each of these four styles. Follow-up interviews with parents assessed the level of satisfaction with the visit, perception that parent's concerns had been addressed, and subsequent telephone calls to the physician. Results indicated that physicians underestimated the degree of interaction desired by the parents. Parent desires for particular communication styles were not predicted by characteristics of the parents. Interaction variables predicted parent perceptions and subsequent need for contact with the physician.

Selective responsiveness of chronically ill children to assessments of depression.

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies. This variation in prevalence rates may be due, in part, to selective reporting of patients based on measures used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the Intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression Inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x Intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.

Self-report, peer-report, and teacher-report measures of childhood depression: an analysis by item.

We explored the low correlation among different types of childhood depression measures at the item level. The items from the Children's Depression Inventory (CDI), Peer Nomination Inventory of Depression (PNID), and the Child Behavior Checklist-Teacher Report Form (CBCL-T) were combined, and both first- and second-order factor analyses were conducted. Results indicate that self-report, peer-report, and teacher-report assessments of depression measure generally uncorrelated constructs. Second-order analysis suggests that depression as a global construct is being measured to some degree by items from all three instruments. Canonical analysis was employed to identify items that best predicted CDI, PNID, and CBL-T summary scores simultaneously. Also, the relationship between specific items with similar content was investigated. Results from these analyses generally supported a conclusion that the three types of measures yield scores that are primarily independent and that the use of summary scores is not masking stronger relationships within measures. These findings have implications for clinical practice and construct elaboration.

Ethical beliefs and behaviors of pediatric psychologists: a survey.

There is an absence of data concerning the beliefs about and compliance with ethical principles of pediatric psychologists. Survey data were collected from 169 psychologist members of the Society of Pediatric Psychology (Division 12, Section 5 of APA) regarding the degree to which they engaged in each of 101 behaviors and the degree to which they considered each behavior ethical. The data were categorized and examined in terms of the APA Ethical Principles. Results indicated that pediatric psychologists show significantly different beliefs and behavior comparing children, adolescents, and their parents. A "majority belief" scale was developed where 80% of pediatric psychologists agreed that a clinical behavior was ethical or not ethical. Female pediatric psychologists, compared to males, more strongly endorsed the majority belief items (p less than .01). In addition, psychologists who graduated from APA-approved graduate programs more strongly endorsed the majority belief items than did psychologists from non-APA programs (p less than .05). Increased awareness of ethical issues is hoped to improve self-regulation by psychologists.

The factor analytic structure of the Roberts Apperception Test for Children: a comparison of the standardization sample with a sample of chronically ill children.

A confirmatory principal component factor analysis of the Roberts Apperception Test for Children was conducted using the standardization sample and a sample of chronically ill children. An interpretation of three- and four-factor solutions identified the three-factor solution as superior to the four-factor solution as measured by chi-square goodness of fit and coefficients of convergence. A cluster analysis using Ward's minimum variance method was calculated to determine the typical profiles that best describe the chronically ill sample. Results of this analysis reveal two distinct profiles that differ primarily on the level of adaptive psychological functioning.

Evaluation of subclinical depression in children using self-, peer-, and teacher-report measures.

This study reports on several classification issues utilizing the Children's Depression Inventory (CDI), the Child Behavior Checklist-Teacher Form (CBCL-T), and the Peer Nomination Inventory of Depression (PNID). The first sample contained 752 public school children in grades 5, 6, and 9. A second sample of 142 fifth-graders was included to have an additional PNID comparison group. Results revealed moderate correlations between the CDI and the CBCL-T and PNID. Use of multiple criteria for selecting children as depressed was discussed, and selection rates using multiple measures with either strict or lenient cutoff scores were given. Normative data on the PNID were evaluated, and it was suggested that norms for the PNID may not be generalizable to other samples. Finally, race and gender analyses showed that CDI scores for females were significantly higher than for males, whereas CDI scores for Hispanics were significantly higher than for non-Hispanic whites. However, Omega-squared analyses for these two variables showed this to be of little practical significance.

The psychosocial impact of play on hospitalized children.

Compared the effects of play on the psychosocial adjustment of 46 children hospitalized for acute illness, who were placed in one of four groups: therapeutic play, diversionary play, verbal support, and no treatment. Ratings of psychological adjustment included self-report, as well as nurse and parent ratings. Children in the therapeutic play condition evidenced a significant reduction in self-reported hospital fears. Parent ratings were not affected by therapeutic treatments; rather, parents in all four groups rated their children less anxious from pre- to posttesting. Results are discussed in terms of methodological considerations that have affected outcomes in this type of research.