PubMed Health⌕ Search

Biomedical subjects

D Drotar

Publications and source records attributed to D Drotar.

At least 37 records · Page 2Linked to original sources
PubMed1998

Acute psychosocial impact of pediatric orthopedic trauma with and without accompanying brain injuries.

BACKGROUND: The acute psychosocial effects of orthopedic injuries on children and their families are poorly understood. Previous studies have relied on retrospective reports or failed to take into account accompanying brain injuries. The purpose of the present study was to examine prospectively the psychosocial impact of pediatric orthopedic traumatic fractures with and without accompanying brain injuries. METHODS: Participants were 108 children 6 to 12 years old with orthopedic injuries requiring hospitalization: group 1 (n=80) had fractures only, group 2 (n=28) also had moderate or severe brain injuries. Using standardized measures and parent interviews, we obtained preinjury estimates of family functioning and child behavior problems and postinjury measures of parental distress, family stresses, and child behavior. RESULTS: Parents reported significant clinical distress (35% in group 1, 57% in group 2), family burdens (group 2 > group 1), and child behavioral changes (41% in group 1, 89% in group 2). Multiple regression analyses indicated that preinjury family status and brain injuries predicted postinjury parental and family distress. CONCLUSION: Pediatric orthopedic injuries have greater social effects on children with accompanying brain injuries and poorer preinjury family functioning.

Adaptation, Psychological↗
PubMed1998

Family burden and adaptation during the initial year after traumatic brain injury in children.

OBJECTIVE: Traumatic brain injury (TBI) often leads to long-term behavioral and cognitive deficits in children. However, little is known about the burden and psychosocial morbidity of pediatric TBI for families. The purpose of this study was to test the hypothesis that moderate and severe TBI in children has more adverse consequences than orthopedic trauma. DESIGN: The sample was comprised of children between the ages of 6 and 12 recruited from hospital trauma and inpatient units including 53 with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries not involving central nervous system insult. Measures of injury-related burden, parental distress, and family functioning were administered to the child's primary caregiver at baseline assessment conducted soon after injury and at 6- and 12-month follow-ups. Multivariate repeated measures analysis of covariance was used to examine group differences in these outcomes over time. RESULTS: Caregivers in the severe TBI group reported significantly higher levels of family burden, injury-related stress, and parental psychological symptoms than caregivers in the orthopedic injury group (ORTHO). The groups did not differ with respect to marital distress. Caregivers in the severe TBI group were significantly more likely than caregivers in the ORTHO group to exceed the clinical cutoff on the Brief Symptom Inventory and to report clinically significant levels of family dysfunction at follow-up. CONCLUSIONS: The findings suggest that severe TBI is a source of considerable caregiver morbidity, even when compared with other traumatic injuries. Caregivers in the severe TBI group had persistent stress associated with the child's injury, as well as the reactions of other family members, and a relative risk of clinically significant psychological symptoms nearly twice that of the ORTHO comparison group. These findings underscore the need for interventions that facilitate family adaptation after pediatric TBI.

Adaptation, Psychological↗
PubMed1997

Correlates of psychological distress among mothers of children and adolescents with hemophilia and HIV infection.

Evaluated the correlates of mood state (psychological distress) in a multisite study of two groups: (a) mothers of HIV-positive children and adolescents with hemophilia (n = 91), and (b) mothers of HIV-negative children and adolescents with hemophilia (n = 92). Socioeconomic status, quality of family relationship support, and frequency of negative life events accounted for significant variance in Total Mood Disturbance (psychological distress) as measured by the Profile of Mood States in the overall sample. Severity of hemophilia was unrelated to distress. A significant interaction between HIV status and frequency of stressful life events indicated that this variable related more strongly to distress among mothers of HIV-infected children and adolescents with hemophilia than among mothers of HIV-negative children with hemophilia. Findings suggest that the presence of HIV infection in their children and adolescents may heighten the impact of negative life events on the psychological distress experienced by these mothers.

Adolescent↗
PubMed1997

Relating parent and family functioning to the psychological adjustment of children with chronic health conditions: what have we learned? What do we need to know?

Reviewed research concerning the relationship of parent and family functioning to the psychological adjustment of children with chronic health conditions. More adaptive family relationships and parental psychological adjustment were associated with positive psychological adjustment while less adaptive family relationships (e.g., greater conflict and maternal psychological distress) consistently predicted problematic adjustment. Conclusions were limited by small, site-specific samples, reliance on self-report measures generally obtained from one parent, and general measures. Research progress would be enhanced by (a) more representative data sets; (b) process-oriented, illness-specific, and clinically relevant measures; (c) prospective analyses that clarify specific causal pathways between family functioning and children's adjustment; and (d) tests of interventions that modify risk and/or resistance factors.

Adaptation, Psychological↗
PubMed1997

Mothers' beliefs about the causes of infant growth deficiency: is there attributional bias?

Tested for defensive attributional bias in mothers' causal explanations for infant (2-12.5 months) growth deficiency. Mothers of healthy babies (controls; n = 82), growth deficient babies without medical problems (n = 27) and growth deficient babies with mild medical problems (n = 22) rated their levels of agreement with 23 causes of growth problems which were designed to vary in the degree of personal threat to parenting self-esteem. Ratings were completed for the mother's (Own) baby and for a nonspecific (Other) baby. Findings partially support a theory of defensive attributional bias, with higher agreement when causes referred to Other (vs. Own) baby, and lower agreement with family-related than with medical/nutritional causes. Factors that may have influenced material experience of threat and implications of the findings for clinical practice are discussed.

Adult↗
PubMed1997

Intervention research: pushing back the frontiers of pediatric psychology.

Intervention research in pediatric psychology assumes special importance given continuing pressures to develop and document the efficacy of interventions for pediatric populations. Studies presented in this issue illustrate the need for flexible approaches to intervention research including case studies and randomized trials, comprehensive assessment of health and psychological outcomes, assessment of social validity, identification of moderators of intervention effects, innovative treatment applications and strategies to integrate research and practice. Recommendations to enhance the scientific basis and clinical relevance of intervention research include using case series to document promising methods, collecting data in practice settings, assessing costs versus benefits, defining and assessing quality of psychological interventions, and conducting randomized clinical trials.

Adolescent↗
PubMed1997

Social competence among children with central nervous system-related chronic health conditions: a review.

Reviewed empirical studies of social competence among children with central nervous system (CNS)-related chronic health conditions published since 1975. The overwhelming majority of studies evaluated social competence at the level of social adjustment; the domains of children's social performance and social skills were relatively neglected (Cavell, 1990). Findings are critiqued with respect to conceptualization of social competence among children with CNS conditions and methodological considerations. Directions for future research include expanding the conceptualization of social competence in this population to include social demands and competencies specific to children with CNS conditions and utilizing explicit theoretical frameworks that allow for competing hypotheses to be tested.

Adolescent↗
PubMed1997

Neurodevelopmental outcomes of Ugandan infants with human immunodeficiency virus type 1 infection.

BACKGROUND: The neurodevelopmental outcomes of human immunodeficiency virus type 1 (HIV-1)-infected Ugandan infants of nondrug-using mothers were studied using controlled, prospective methodology. METHOD: The sample of 436 full-term infants included 79 HIV-infected infants of HIV-1-infected mothers, 241 uninfected infants of HIV-1-infected mothers (seroreverters), and 116 uninfected infants born to HIV-negative mothers. Neurologic status, information processing ability, and motor and mental development were assessed from 6 to 24 months of age. Observations of caretaker-child interaction and home environments were made at 6 and 12 months. All evaluators were blinded to the HIV status of the child and family. RESULTS: Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated greater deficits in motor development and neurologic status, and more frequent and earlier onset of motor and neurologic abnormalities. Compared with controls, HIV-infected infants had more abnormalities in mental development at 6 and 18 months and an earlier onset of abnormalities. By 12 months, 30% of HIV-infected infants demonstrated motor abnormalities and 26% cognitive abnormalities as compared with 11% and 6% among seroreverters and 5% and 6% among seronegative infants. HIV-infected infants (62%) demonstrated a higher probability of developing an abnormal neurologic examination by 12 months, compared with seroreverters (17%) or seronegative infants (15%). Information-processing abilities did not differ as a function of HIV infection. Home environments and infants' interactions with caretakers were similar across groups. CONCLUSION: We conclude that HIV infection results in more frequent and earlier abnormalities in infants' neurologic status and motor development that are not attributable to other biological and environmental risk factors. More frequent mental developmental abnormalities were evident at several ages. However, information-processing abilities, such as recognition memory, may be spared from HIV-related deficits.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Preinjury family environment as a determinant of recovery from traumatic brain injuries in school-age children.

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than environmental factors as predictors of recovery. We addressed this concern using data collected during a prospective study of children with either TBI or orthopedic injuries (OI) and their families. Participants included 53 children with severe TBI, 56 with moderate TBI, and 80 with OI, all from 6 to 12 years of age at the time of injury. Measures of the preinjury family environment were collected shortly after the injury (baseline). Child cognitive and behavioral outcomes were assessed at baseline and at 6- and 12-month follow-ups. Individual growth curve analyses showed that measures of the preinjury family environment consistently predicted both the level of cognitive and behavioral functioning at 12 months postinjury and the rate of intraindividual change during the 12-month follow-up period, even after taking into account group membership and injury severity. In some cases, the preinjury family environment was a significant moderator of the effect of TBI, buffering its impact in high-functioning families and exacerbating it in low-functioning families. Thus, preinjury environmental factors predict recovery following TBI in children, even after accounting for injury-related variables.

Brain Injuries↗
PubMed1996

Impact of the repressive personality style on the measurement of psychological distress in children and adolescents with chronic illness: an example from hemophilia.

Described the impact of the repressive personality style on the measurement of psychological distress among children and adolescents with hemophilia. Two groups were compared on parent and self-report measures of anxiety and depression: a nondefensive group (n = 34) with low distress; and a highly defensive group (n = 26) who were identified as having a repressive personality style and who also reported low distress. Consistent with hypotheses, highly defensive children reported comparable levels of anxiety and lower levels of depression than nondefensive children. On the other hand, mothers of highly defensive children and adolescents described them as more distressed than mothers of nondefensive (self-assured) children. Findings underscore the importance of including data from other informants, (e.g., parents, teachers, or peers) to avoid misleading findings based on self-reports of anxiety and depression obtained from highly defensive children.

Adolescent↗
PubMed1996

Quality of attachment as a predictor of maternal visitation to young hospitalized children.

Tested a comprehensive model of factors predicting maternal visitation with hospitalized children. Subjects were 86 mothers who completed the Spielberger State-Trait Anxiety Inventory, a 12-item attachment measure derived from the Waters and Deane Attachment Q-sort, and a demographic questionnaire. Children were 10 months to 4 years old (37 female, 49 male) and hospitalized for acute nonsurgical illness. Hierarchical regression analyses indicated that, of the subset of variables tested (SES, number of children at home, gender, age, number of previous hospitalizations, state anxiety, and security of attachment), quality of attachment was the only significant predictor of maternal visitation rate. Mothers who reported that their children displayed insecure attachment behaviors maintained a significantly lower rate of visitation than mothers who reported that their children displayed secure attachment behaviors. Results of this study highlight the importance of understanding parent-child attachment in predicting maternal visitation when a child is hospitalized.

Child, Hospitalized↗
PubMed1996

Prediction of children's postoperative pain: the role of presurgical expectations and anticipatory emotions.

Examined predictors of children's ratings of postoperative pain intensity based on a model of children's expectations for surgery developed from the Children's Health Belief Model (Bush & Iannotti, 1990) and McGrath's (1990) model of children's pain experiences. Prior to their inpatient surgeries, 28 children (ages 7-17 years) and their parents completed ratings of children's expected surgery pain, anticipatory anxiety, and expected helpfulness of pain medicine. Following surgery, children completed ratings of their postoperative pain intensity. Age, total analgesics administered, and anticipatory anxiety emerged as significant predictors of children's postoperative pain ratings. Methodological issues concerning the measurement of children's expectations for surgery are discussed.

Adaptation, Psychological↗
PubMed1996

Family and parental functioning in cystic fibrosis.

This article reviews 31 recent articles that describe the functioning of families and/or parents of children with cystic fibrosis (CF), compares them to families of healthy children, pinpoints factors that predict quality of adjustment, or evaluates interventions designed to improve functioning. Commonly cited concerns included the difficulty of the treatment regimen, the terminal nature of CF, and the disruption of intrafamilial relationships. Parents of children with CF experienced greater stress and burdens than parents of healthy children, yet parenting behavior and family functioning were quite similar in CF and healthy control groups. Higher levels of distress, an avoidant coping style, and low levels of family support were associated with poor psychological adjustment. Recommendations for future research include: using multiple informants; using detailed, illness-specific measures and conceptual frameworks; and conducting studies of individual variation and interventions. Practitioners might consider performing periodic updates of how the family is managing as a whole.

Child↗
PubMed1996

Childhood traumatic brain injury: initial impact on the family.

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in children, resulting in a wide range of cognitive and behavioral sequelae. However, little is known about the effects of pediatric TBI and its aftermath on families. The current investigation examined the impact of TBI on families during the first month following injury. Children with orthopedic injuries requiring hospitalization served as a control group. The sample consisted of 44 families of children of severe TBI, 52 families of children with moderate TBI, and 69 families of children with orthopedic injuries not involving the central nervous system (CNS). Families of children with severe TBI experienced significantly more injury-related stress than the other two groups of families. Parents of children with TBI also reported higher levels of psychological symptoms than parents of children with orthopedic injuries. Findings from regression analyses suggested that families facing multiple stressors in addition to the injury and those who cope poorly may be at greatest risk for adverse consequences. Future interventions could provide anticipatory guidance and support to at-risk families.

Adaptation, Psychological↗
PubMed1995

Social competence in children with IDDM and asthma: child, teacher, and parent reports of children's social adjustment, social performance, and social skills.

Used Cavell's (1990) model of childhood social competence to compare the social competence in peer relations of 25 children (ages 8-10 years) with insulin-dependent diabetes mellitus (IDDM), 19 children with asthma, and 24 physically healthy children. Children were individually matched for economic status, race, gender, and age. Children, their parents, and their teachers completed measures of children's social adjustment, social performance, and social skills in peer relations. Contrary to hypotheses, no differences between the groups of children were noted on any of the measures of social competence. Results are discussed in terms of the resiliency of children's social competence to these chronic conditions.

Adjustment Disorders↗
PubMed1995

Case reports in pediatric psychology: uses and guidelines for authors and reviewers.

Described uses of case reports in pediatric psychology and guidelines for authors and reviewers. Case reports have several important functions: to document the efficacy of new treatment applications, describe interesting new clinical phenomena, to develop hypotheses, to illustrate methodological issues, difficult diagnostic issues, or novel treatment approaches, and to identify unmet clinical and research needs. Authors should carefully document the scientific purpose and clarify the new information contributed by their reports, provide evidence for their conclusions, and articulate clinical, theoretical, and/or research implications.

Child↗