Self-reported eating disorders and sleep disturbances in young adults: a prospective cohort study.

PURPOSE: To evaluate the prospective association between eating disorders, disordered eating behaviors, and sleep disturbances in young adults. METHODS: We used prospective cohort data of young adults aged 18-26 from the National Longitudinal Study of Adolescent to Adult Health (N = 12,082). Self-reported exposures of interest (at 18-26 years) included (1) an eating disorder diagnosis proxy; disordered eating behaviors such as (2) restrictive eating behaviors including fasting/skipping meals, (3) compensatory behaviors including vomiting, laxatives/diuretics, or weight loss pills; and (4) loss of control/overeating. Self-reported sleep disturbances at 7-year follow-up included trouble falling or staying asleep. RESULTS: In negative binomial regression models, all four exposures predicted both sleep disturbance outcomes at 7-year follow-up, when adjusting for demographic covariates and baseline sleep disturbances. When additionally adjusting for baseline depressive symptoms, the associations between eating disorder diagnosis proxies and trouble falling (incidence rate ratio [IRR] 1.24; 95% CI 1.05-1.46) and staying (IRR 1.16; 95% CI 1.01-1.35) asleep remained statistically significant; however, the associations between eating behaviors and sleep disturbances were attenuated. CONCLUSIONS: Eating disorders in young adulthood predict sleep disturbances at 7-year follow-up. Young adults with eating disorders or who engage in disordered eating behaviors may be assessed for sleep disturbances. LEVEL III: Evidence obtained from well-designed cohort or case-control analytic studies.

Effects of Mindfulness-Based Positive Behavior Support (MBPBS) Training Are Equally Beneficial for Mothers and Their Children With Autism Spectrum Disorder or With Intellectual Disabilities.

Parenting a child with autism spectrum disorder (ASD) or intellectual disabilities (IDs) can be stressful for many parents. Mindfulness-Based Positive Behavior Support (MBPBS) is a customized mindfulness program that enables parents and other caregivers to reduce their perceived psychological stress to normative levels through mindfulness procedures and to support children with ASD or ID to self-manage their challenging behaviors through positive behavior support (PBS). In this study, we evaluated whether MBPBS would have differential effects on the stress levels of mothers of adolescents with ASD (n = 47) or with ID (n = 45) and the effects of the program on the aggressive, disruptive, and compliance behaviors of their children. Both groups of mothers participated in the 40-week study (10 weeks control and 30 weeks MBPBS program), rated their own stress levels, and collected daily observational data on the adolescents' behavior. Results showed significant reductions in the level of stress in both groups of mothers, but no differential effects on mothers of children with ASD or with ID. In addition, significant reductions in aggression and disruptive behavior and increases in compliance behaviors were observed in the adolescents in both groups. The results suggest that MBPBS is equally beneficial for mothers of adolescents with ASD or ID. In the present study, although the mothers of children with ID had slightly higher levels of stress at baseline and mothers of children with ASD had lower levels of stress following the MBPBS program, the program can be considered equally effective in reducing the stress levels of both groups of mothers. This suggests that the program may be effective regardless of baseline levels of mothers' stress.

Can a Mediator Moderate? Considering the Role of Time and Change in the Mediator-Moderator Distinction.

The concepts of mediation and moderation are important for specifying ways in which psychological treatments work and for whom they are most beneficial. Historically, the terms were confused and used interchangeably, so a rich body of scholarly literature makes clear their distinction. Researchers are also becoming increasingly aware that mediation and moderation can be integrated and that such integration can advance theory development and testing. One question that has not received sufficient attention is whether a mediator can simultaneously moderate. We tackle this question in this paper, and in doing so we expand on the MacArthur conceptualizations of mediation and moderation. The result is a presentation of a meta-theoretical model that illustrates how a construct that is initially a mediator can, not simultaneously but over time, evolve into a construct that moderates. When this occurs, a construct that changed for the better as a result of an intervention can later promote more positive change during a later intervention. Various implications of this novel paradigm for future research are discussed, including the importance of this model in the emerging context of managed health care.

The effect of functionality-focused and appearance-focused images of models of mixed body sizes on women's state-oriented body appreciation.

Research demonstrates that exposure to appearance-focused images of models depicting societal standards of beauty negatively affect women's state-oriented body dissatisfaction. The purpose of this research was to extend this experimental research to women's state-oriented body appreciation. The 374 women participants were randomly assigned to view images that were either depicting a model who was representative or not representative of the thin ideal (body size), while this model was in either an appearance-focused pose or a function-oriented pose (pose type). State body appreciation increased significantly after viewing images depicting models who did not conform to societal standards of thinness (p<0.001). Exposure to the control condition images, which were images of natural environments, also produced increases in state body appreciation (p=0.049). These findings provide insight into the construct of state body appreciation and offer implications for future positive body image research.

Does Social Support Buffer the Association Between Stress Eating and Weight Gain During the Transition to College? Differences by Gender.

This study sought to examine whether social support moderates the relationship between stress eating and body mass index (BMI) change over the freshman year in males and females. This longitudinal study included 70 college students (72.9% female; M age = 18.23) who completed self-reported measures of stress eating and perceived social support, with objective height and weight measurements collected. Among males, social support moderated the relationship between stress eating and BMI change. Among males, social support may serve as a buffer against the impact of stress eating on weight gain during the freshman year of college.

A mindfulness-based intervention for self-management of verbal and physical aggression by adolescents with Prader-Willi syndrome.

PURPOSE: There is a dearth of clinical and research literature on the treatment of maladaptive behaviors in adolescents with Prader-Willi syndrome (PWS). The purpose of this study was to evaluate the effectiveness of a mindfulness-based intervention, Meditation on the Soles of the Feet (SoF), to facilitate self-management of verbal and physical aggression. METHOD: We utilized a multiple-baseline design across participants to test the intervention with three adolescents diagnosed with PWS. RESULTS: Relative to baseline, verbal aggression decreased to minimal levels following mindfulness-based practice and physical aggression was nearly eliminated. Intervention effects were maintained at 12-month follow-up. Quantitative analytics confirmed statistically significant outcomes. CONCLUSIONS: The SoF mindfulness intervention was effective in reducing verbal and physical aggression in three adolescents with PWS. Future research should test the SoF intervention with this clinical population in a larger clinical trial, and the SoF intervention may be applicable to other pediatric populations.

The complex relationship between personal sense of connection to animals and self-reported proenvironmental behaviors by zoo visitors.

The global biodiversity crisis requires an engaged citizenry that provides collective support for public policies and recognizes the consequences of personal consumption decisions. Understanding the factors that affect personal engagement in proenvironmental behaviors is essential for the development of actionable conservation solutions. Zoos and aquariums may be some of the only places where many people can explore their relations with wild animals and proenvironmental behaviors. Using a moderated-mediation analysis of a survey of U.S. zoo and aquarium visitors (n = 3588), we explored the relationship between the sense of connection to animals and self-reported engagement in proenvironmental behaviors related to climate change and how this relationship is affected by certainty that climate change is happening, level of concern about climate change, and perceptions of effectiveness in personally addressing climate change. We found a significant, directional relationship between sense of connection to animals and self-reported proenvironmental behaviors. Political inclination within the conservative to liberal spectrum did not affect the relationship. We conclude that a personal sense of connection to animals may provide a foundation for educational and communication strategies to enhance involvement in proenvironmental actions.

Is body dissatisfaction changing across time? A cross-temporal meta-analysis.

It remains unclear whether body dissatisfaction, a widely recognized predictor of eating-related pathologies and depressive symptomatology, is consistent across cohorts and time. This question is important to investigate because dominant theories propose that sociocultural influences, which may fluctuate, play an important role in the development of body dissatisfaction. Previous efforts for tracking body dissatisfaction across cohorts and time are limited by relying on data from a single institution or using assessments that lack psychometric support across genders. In this study, we utilized cross-temporal meta-analyses to examine changes in 2 dimensions of body dissatisfaction: thinness-oriented dissatisfaction as assessed with the Eating Disorder Inventory-Body Dissatisfaction subscale (data available across 31 years from 326 unique samples, n = 100,228 participants) and muscularity-oriented dissatisfaction as measured with the Drive for Muscularity Scale (data available across 14 years from 117 unique samples, n = 23,575 participants). Results revealed a significant interaction between year of study and gender in predicting thinness-oriented dissatisfaction: girls and women scored higher than boys and men consistently (ds = 0.51-1.17), although only girls' and women's scores decreased gradually across time (d = 0.49). Boys and men scored higher than girls and women on muscularity-oriented dissatisfaction (d = 1.72), with no significant changes across time. These patterns remained when controlling for age and geographic location. Overall, these findings highlight the importance of considering multiple dimensions of body dissatisfaction in research and offer evidence that sociocultural shifts in body acceptance and diversity may be countering thinness-related pressures for girls and women. (PsycINFO Database Record

Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) vs. Training-as-Usual (TAU): A Randomized Controlled Trial.

Caregivers of individuals with intellectual and developmental disabilities (IDD) often end up having their medical and psychological well-being compromised due to the stressful nature of caregiving, especially when those in their care engage in aggressive behavior. In this study, we provided caregivers with mindfulness-based training to enable them to better manage their psychological well-being and, through this, to also enhance specific indices of quality of life of the individuals in their care. Thus, the aim of the present study was to evaluate in a randomized controlled trial (RCT) the comparative effectiveness of Mindfulness-Based Positive Behavior Support (MBPBS) and Training-as-Usual (TAU) for caregivers in a congregate care facility for individuals with severe and profound IDD. The comparative effects of the two training conditions were assessed in terms of caregiver variables care recipient variable (number of aggressive events), and agency variables Results showed that MBPBS was significantly more effective than TAU in enabling the caregivers to manage their perceived psychological stress, and to reduce the use of physical restraints and stat medications for aggressive behavior of the individuals in their care. In addition, there were significant reductions in aggressive events by the individuals in their care, 1:1 staffing of individuals with aggressive behavior, and staff turnover. Furthermore, the MBPBS training was significantly more cost-effective than the TAU training. If replicated in future RCT studies, MBPBS may provide an effective means of enhancing socially acceptable bidirectional engagement of caregivers and care recipients within a person-centered context.

Caregiver Training in Mindfulness-Based Positive Behavior Supports (MBPBS): Effects on Caregivers and Adults with Intellectual and Developmental Disabilities.

Caregivers often manage the aggressive behavior of individuals with intellectual and developmental disabilities that reside in community group homes. Sometimes this results in adverse outcomes for both the caregivers and the care recipients. We provided a 7-day intensive Mindfulness-Based Positive Behavior Support (MBPBS) training to caregivers from community group homes and assessed the outcomes in terms of caregiver variables, individuals' behaviors, and an administrative outcome. When compared to pre-MBPBS training, the MBPBS training resulted in the caregivers using significantly less physical restraints, and staff stress and staff turnover were considerably reduced. The frequency of injury to caregivers and peers caused by the individuals was significantly reduced. A benefit-cost analysis showed substantial financial savings due to staff participation in the MBPBS program. This study provides further proof-of-concept for the effectiveness of MBPBS training for caregivers, and strengthens the call for training staff in mindfulness meditation.

Trajectories of oral medication adherence in youth with inflammatory bowel disease.

OBJECTIVE: To examine longitudinal trajectories of oral thiopurine adherence over a 180-day interval in a sample of youth with inflammatory bowel disease (IBD) and to identify the role of disease activity, length of time since diagnosis, and regimen complexity in predicting adherence trajectory class membership. METHOD: Participants included 96 adolescents (M age = 14.32 years) with IBD. Oral medication adherence was assessed via MEMS Track Caps (i.e., an electronic monitor that allows for real-time assessment of adherence) for 6 months, after which time devices were collected and data were downloaded. Medical record reviews provided information about participants' disease activity, length of time since diagnosis, and regimen complexity (including both medications and supplements) at the time of study enrollment. RESULTS: Two distinct adherence trajectory classes emerged: Group 1 represented those with consistently near-perfect adherence, whereas Group 2 represented those with mild nonadherence that increased with time. Complexity of medication regimen emerged as the only predictor of trajectory class, with adolescents whose regimen involved more than 1 daily medication administration time being more likely to be classified in Group 2 (i.e., the consistently near-perfect adherence group) than those whose regimen involved only 1 daily medication administration time. CONCLUSIONS: Distinct classes of adherence trajectories in pediatric IBD can be identified with longitudinal data collection approaches; however, disease and regimen factors offered limited value in predicting adherence trajectory class. Future research should utilize longitudinal conceptualizations of adherence and examine alternative predictors of declining adherence over time.

The effect of thin and muscular images on women's body satisfaction.

A substantial body of research documents that exposure to images depicting a "thin ideal" body figure effects women's state-oriented body satisfaction. However, there is evidence that the societal ideal body figure of females is evolving to be not just thin, but also muscular or toned. Therefore, the purpose of this research was to test the effect of exposure to ideal body figures that are both thin and muscular on female state body satisfaction. Researchers recruited female participants (N=366) from an online community (Amazon's Mechanical Turk) and randomly assigned them to view images in one of four conditions: thin, thin and muscular, thin and hypermuscular, and control (images of cars). Results indicated that state-oriented body satisfaction decreased in the thin condition and thin and muscular condition, but not the hypermuscular or control conditions. These findings have implications for clinical initiatives as well as future research.

Integrating mediation and moderation to advance theory development and testing.

OBJECTIVE: The concepts and associated analyses of mediation and moderation are important to the field of psychology. Although pediatric psychologists frequently incorporate mediation and moderation in their theories and empirical research, on few occasions have we integrated mediation and moderation. In this article, conceptual reasons for integrating mediation and moderation are offered. METHOD: We illustrate a model that integrates mediation and moderation. RESULTS: In our illustration, the strength of an indirect or a mediating effect varied as a function of a moderating variable. CONCLUSIONS: Clinical implications of the integration of mediation and moderation are discussed, as is the potential of integrated models to advance research programs in pediatric psychology.

Evidence-based assessment of childhood injuries and physical risk-taking behaviors.

OBJECTIVE: To offer a critical evidence-based review and summary of assessment methods of childhood injuries and physical risk-taking behaviors. METHODS: A literature review was conducted to identify methodologies for assessing injury events and physical risk-taking behaviors. Methodologies reviewed included self- or parent-report scales, behavioral observations, and participant event monitoring. We classified methodologies according to published criteria of "well-established," "approaching well-established," or "promising." RESULTS: 7 methodologies were classified as "well-established", 9 were classified as "approaching well-established", and 8 were classified as "promising." CONCLUSIONS: Several approaches to assessing injuries or physical risk-taking behaviors have strong psychometric properties. Opportunities for further psychometric validation of techniques are noted. It is hoped that this review inspires researchers throughout the fields of pediatric and clinical child psychology to adopt assessments of injury and physical risk-taking in their ongoing research efforts.

Thinking meta-theoretically about the role of internalization in the development of body dissatisfaction and body change behaviors.

Internalization of societal standards of physical attractiveness (i.e., internalization of the thin ideal for women and internalization of the mesomorphic ideal for men) is a widely studied and robust risk factor for body dissatisfaction and maladaptive body change behaviors. Substantial empirical research supports internalization as both a mediator and a moderator of the relation between societal influences and body dissatisfaction. In this paper, a primer on mediation and moderation is followed by a review of literature and discussion of the extent to which internalization can theoretically fulfill the roles of both mediation and moderation. The literature review revealed a stark contrast in research design (experimental versus non-experimental design) when alternate conceptualizations of internalization are adopted. A meta-theoretical, moderated mediation model is presented. This model integrates previous research and can inform future empirical and clinical endeavors.

Graduate admissions in clinical neuropsychology: the importance of undergraduate training.

Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.

Supervision to prevent childhood unintentional injury: developmental knowledge and self-efficacy count.

Caregiver developmental knowledge was tested as a moderator of the association between caregiver-perceived self-efficacy and perceived supervision to prevent childhood unintentional injury. Caregivers (N = 123; 95 mothers and 28 fathers) of children (M = 3.5 ± 1.2 years, 49.6% female, 80.8% Caucasian) were recruited from pediatric primary care offices and local message boards. All caregivers completed self-report questionnaires on perceived self-efficacy, developmental knowledge, and perceived supervision to prevent injury. Separate hierarchical linear regression models were conducted to test moderation for mothers and fathers. The interaction effect of perceived self-efficacy and developmental knowledge significantly predicted maternal-perceived supervision, R (2) change = .06, F(1, 86) = 6.76, p < .01. No significant findings were detected for fathers. Models of studying injury prevention that consider complex cognitive-behavioral interactions and their potential modifiable role in the development of injury-prevention practices may elucidate upon the attitude-practice gap currently identified in the literature.