Identifying psychosocial risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients.

PURPOSE: The primary purpose of this prospective study was to identify the level of risk for psychosocial distress in families of children newly diagnosed with cancer. Additional study aims were to examine concordance among family and staff reports of psychosocial risk, changes in risk status over time, and to predict the use of psychosocial resources during the first months of treatment. PATIENTS AND METHODS: Caregivers of 125 children newly diagnosed with cancer completed the Psychosocial Assessment Tool (PAT) at diagnosis (t1) and 3 to 6 months later (t2). Primary oncologists and nurses completed an analogous measure of perceived family psychosocial risk at t1 and t2. At t2, oncology social workers reported types and intensity of psychosocial interventions provided. RESULTS: The PAT identified three subsets of families who presented with increasing levels of psychosocial risk at diagnosis. In general, there was moderate concordance among family, oncologist, and nurse reports of psychosocial risk. PAT scores at t1 predicted t2 PAT scores and psychosocial resource use at t2 beyond demographic or disease factors. CONCLUSION: A brief screening tool (PAT) is valuable in identifying psychosocial risk factors at diagnosis and is predictive of later use of psychosocial resources. As a next step in this research, the development of psychosocial interventions to match family risk level may be an effective and cost-efficient approach to working with families to address their concerns and promote short- and long-term adjustment.

Brief report: Cross-cultural replication of an anomalous psychometric pattern in children with type 1 diabetes.

OBJECTIVE: To replicate an anomalous psychometric profile previously documented in children with Type 1 diabetes living in the mainland United States with a cross-cultural sample selected from Puerto Rico. METHODS: Ninety-three Spanish-speaking children (M age = 12.8 years) with Type 1 diabetes living in Puerto Rico were administered the Puerto Rican version of the Wechsler Intelligence Scale for Children-Revised (WISC-R). The factor structure of the Puerto Rican sample's WISC-R was then compared to that of a United States sample (n = 95) in which an anomalous factor structure in children with diabetes was first documented. RESULTS: As in the United States sample, a four-factor IQ structure was obtained. Instead of the traditional three-factor structure of the WISC-R, the Perceptual Organization factor split into a Spatial Conceptual factor and an anomalous Visual Discrimination factor. CONCLUSIONS: Results support previous findings and suggest anomalies in the psychometric profiles of children with Type 1 diabetes. Cross-cultural replication of the anomalous IQ factor structure, and atypical visual discrimination, suggests that differences are illness-related, and consideration may therefore be warranted when administering some subtests of the Wechsler scales to children with Type 1 diabetes.