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Biomedical subjects

J W Varni

Publications and source records attributed to J W Varni.

At least 37 records · Page 2Linked to original sources
PubMed1996

Assessing chronic musculoskeletal pain associated with rheumatic disease: further validation of the pediatric pain questionnaire.

Evaluated the validity, stability, and clinical utility of the Pediatric Pain Questionnaire (PPQ), a comprehensive, multidimensional instrument for assessing childhood pain. Previous studies demonstrated adequate psychometric properties of the PPQ using small samples. Results of the current study, using a large sample (N = 100) of children and adolescents with chronic pain associated with rheumatic disease, were consistent with initial validation studies. High correlations were found among visual analog scale (VAS) pain intensity ratings obtained from parents, physicians, and patients. Significant correlations also were found between pain ratings and measures of disease activity and functional status. VAS ratings evidenced moderate stability over a 6-month period in this sample of youth with relatively stable disease activity. Other components of the PPQ provide comprehensive information that is clinically useful for treatment planning and evaluation.

Activities of Daily Living↗
PubMed1996

Family functioning predictors of adjustment in children with newly diagnosed cancer: a prospective analysis.

Theoretically-driven investigations on the potentially modifiable predictors of individual differences among newly-diagnosed pediatric cancer patients may facilitate the identification of children at risk for adjustment problems. Within a risk and resistance conceptual model, family functioning was investigated concurrently and prospectively as a predictor of adjustment in newly-diagnosed pediatric cancer patients at Time 1 (within 1 month after diagnosis), Time 2 (6 months postdiagnosis), and Time 3 (9 months postdiagnosis). The family relationship dimensions of cohesion and expressiveness most consistently predicted the psychological and social adjustment of children with newly-diagnosed cancer over a 9-month period after initial diagnosis. These findings are discussed in terms of the treatment implications for enhancing child adjustment to newly-diagnosed cancer and biomedical treatment.

Adaptation, Psychological↗
PubMed1996

Chronic pain and emotional distress in children and adolescents.

Pediatric chronic pain continues to be relatively underinvestigated and undertreated. The objective of the present cross-sectional study was to investigate the emotional distress hypothesized to be concurrently associated with the chronic pain experience in children and adolescents. One hundred and sixty children and adolescents with chronic pain and their parents completed standardized assessment instruments measuring pain intensity, depressive symptoms, state anxiety, trait anxiety, general self-esteem, and internalizing and externalizing behavior problems. Consistent with the a priori Biobehavioral Model of Pediatric Pain, higher patient-perceived pain intensity was associated with higher depressive and anxious symptoms, lower general self-esteem, and higher behavior problems. The results are discussed in regard to preventing and treating pain and suffering in children and adolescents with chronic pain.

Adaptation, Psychological↗
PubMed1995

Perceived physical appearance and adjustment of children with newly diagnosed cancer: a path analytic model.

More intensive medical treatment protocols have been initiated with the goal of improving survival of pediatric cancer patients. Evaluation of the adjustment of this cohort of children with newly diagnosed cancer being treated with these modern regimens is essential in order to enhance quality of life. Children with cancer who experience disease and treatment-related changes in physical appearance are hypothesized to be at greater risk for psychological and social adjustment problems given society's attitudes toward visible physical differences. Within a risk and resistance theoretical framework, perceived physical appearance was investigated as a predictor of depressive symptoms, social anxiety, and general self-esteem in newly diagnosed pediatric cancer patients. In support of the a priori conceptual model, path analysis findings indicate that perceived physical appearance has direct and indirect effects on depressive symptoms and social anxiety with the indirect effects mediated by general self-esteem. Exploratory analysis suggests that the effect of perceived physical appearance on general self-esteem may be attenuated by modifiable competence/adequacy domains which have implications for the development of treatment interventions for children with newly diagnosed cancer.

Adaptation, Psychological↗
PubMed1994

Perceived social support and adjustment of children with newly diagnosed cancer.

The negative impact on psychologic adjustment from the stress of living with newly diagnosed cancer is hypothesized to be affected by perceived social support. Thirty children with newly diagnosed cancer completed standardized assessment instruments measuring depressive symptoms, state anxiety, trait anxiety, social anxiety, general self-esteem, and perceived social support from classmates, parents, teachers, and friends. Their parents completed a standardized assessment instrument measuring internalizing and externalizing behavior problems. Perceived classmate, parent, and teacher social support were variously correlated with the psychologic adjustment parameters in the hypothesized direction of greater support predicting lower psychologic distress and higher self-esteem. Hierarchical multiple regression analyses identified perceived classmate social support as the most consistent predictor of adaptation, providing further evidence of the essential function of the social environment of the school setting in affecting the adjustment of children with newly diagnosed cancer.

Adaptation, Psychological↗
PubMed1993

Social support and social cognitive problem-solving in children with newly diagnosed cancer.

Children newly diagnosed with cancer have been documented to be at increased risk for difficulties in their return to school and ongoing positive social experiences. This article reviews the critical role of social support in helping children adjust to their illness and treatment. Social skills training for newly diagnosed children is presented as an important intervention strategy for increasing positive social interactions and overall psychosocial adjustment. A randomized, clinical research trial currently in progress that will evaluate the impact of social skills training on newly diagnosed children 5-13 years of age is delineated. The potentially positive impact of social skills training on the prevention of emotional problems and increased biologic survival are discussed.

Adolescent↗
PubMed1993

The impact of social skills training on the adjustment of children with newly diagnosed cancer.

Randomized 64 children ages 5 to 13 years with newly diagnosed cancer to either a Social Skills Training experimental treatment group or a School Reintegration standard treatment group. Children who received explicit training in social skills reported higher perceived classmate and teacher social support at the 9-month follow-up in comparison to pretreatment levels, while parents reported a decrease in internalizing and externalizing behavior problems and an increase in school competence. Methodological improvements for Phase III clinical trials are addressed.

Adaptation, Psychological↗
PubMed1993

Effects of parental adjustment on the adaptation of children with congenital or acquired limb deficiencies.

Maternal and paternal depression, anxiety, and marital discord were investigated as predictors of depression, anxiety, and self-esteem in 54 children with congenital or acquired limb deficiencies. Higher paternal depression predicted higher child depression and higher anxiety. Higher paternal anxiety predicted higher child depression and anxiety and lower self-esteem. Higher marital discord predicted higher child depression and anxiety and lower self-esteem. Maternal depression and anxiety did not predict child psychological adaptation. Family support had a positive effect on child adaptation, as did parent, classmate, teacher, and friend social support. The findings are discussed in terms of the risk and protective effects of parental distress, marital discord, and social support on the psychological adaptation of children with visible chronic physical disorders. J Dev Behav Pediatr 14:13-20, 1993. Index terms: limb deficiencies, children, adjustment, social support, parental distress, family functioning, marital discord.

Adaptation, Psychological↗
PubMed1992

Screening for behavioral and emotional problems in children and adolescents with congenital or acquired limb deficiencies.

Children with chronic physical handicaps have been found to be at risk for psychological and social adjustment problems. Accurately identifying in a timely manner those physically handicapped children who are functioning at clinically significant levels of maladjustment may aid in preventing further psychosocial morbidity. The parents of 111 children and adolescents with congenital/acquired limb deficiencies completed the Child Behavior Checklist as a screening instrument to facilitate the identification of behavioral and emotional problems and social incompetence. Based on normalized T scores, the children manifested significantly greater behavioral and emotional problems and lower social competence than the normative community sample. Twenty-three percent of the children were reported to function in the clinically significant maladjustment range for behavioral and emotional problems; 14% were reported in the social maladjustment range. Correlations between parent report and child, adolescent, and teacher reports of adjustment ranged from r values of .23 to .41. The findings are discussed in terms of the "new hidden morbidity" in pediatric practice.

Adolescent↗
PubMed1992

Psychological adjustment and perceived social support in children with congenital/acquired limb deficiencies.

The negative impact on psychological adjustment from the chronic strain of living with limb deficiencies appears to be mediated by perceived social support. A multifactorial investigation was conducted to identify empirically psychological adjustment correlates of perceived social support in 49 children with congenital/acquired limb deficiencies. A multiplicity of adjustment factors (depression, trait anxiety, self-esteem) was variously related to perceived parent, teacher, classmate, and friend social support. Hierarchical multiple regression analyses provide initial evidence of the potentially powerful effects of the social environment of the school setting, with perceived classmate social support the only significant predictor variable across depressive symptomatology, trait anxiety, and general self-esteem. The results are discussed as the first step in identifying the potential correlates of multiple perceived social support domains, which may provide empirical guidance for future intervention studies designed to modify adjustment factors in chronically ill and handicapped children.

Adaptation, Psychological↗
PubMed1992

Teacher, parent, and child evaluative ratings of a school reintegration intervention for children with newly diagnosed cancer.

The disruption of school participation and accompanying social experiences because of cancer and its treatment has been related to major problems in adaptation to the disease. For the child with cancer, continuation of his/her social and academic activities provides an important opportunity to normalize as much as possible a very difficult experience. The present study reports on the children's, parents', and teachers' subjective evaluations of the benefits of a comprehensive school reintegration intervention. Forty-nine children, newly diagnosed with cancer, received comprehensive school reintegration consisting of supportive counseling, educational presentations, systematic liaison between the hospital and the school, and periodic follow-ups. Children parents, and teachers were asked to rate their perceptions of the utility and value of the intervention approach. Overall subjective evaluations were very positive, providing support for the social validity of the school reintegration approach for children with newly diagnosed cancer.

Child↗
PubMed1992

Evaluation and management of pain in children with juvenile rheumatoid arthritis.

The systematic evaluation and management of chronic and recurrent pain in children with juvenile rheumatoid arthritis (JRA) is only in the beginning stages of empirical development. While recent advances have been made in the assessment of pain secondary to JRA, very little clinical research has been targeted toward pain management. Development of reliable and valid pediatric pain measures is the first step in advocating controlled clinical trials with pain as an essential outcome variable.

Arthritis, Juvenile↗
PubMed1992

Cognitive-behavioral pain management in children with juvenile rheumatoid arthritis.

Decreasing chronic joint pain is a major goal in the management of juvenile rheumatoid arthritis. Cognitive-behavioral self-regulatory techniques were taught to children with juvenile rheumatoid arthritis to reduce musculoskeletal pain intensity and to facilitate better adaptive functioning. Subjects were 13 children between the ages of 4.5 and 16.9 years who had pauciarticular or systemic onset juvenile rheumatoid arthritis. Baseline data included an initial comprehensive assessment of pain, disease activity, and level of functional disability, as well as pain intensity ratings gathered over a 4-week period. Subjects were seen for eight individual sessions in which self-regulatory techniques (progressive muscle relaxation, guided imagery, meditative breathing) were taught, and parents were seen for two sessions in which key aspects of behavioral pain management techniques were reviewed. Results indicated that these techniques led to substantial reduction of pain intensity, which generalized to outside the clinic setting. Six- and 12-month follow-up data showed consistent decreases in pain as well as improved adaptive functioning. The data suggest that cognitive-behavioral interventions for pain are an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis.

Adolescent↗
PubMed1991

Evaluation and management of pain in children with rheumatic diseases.

The evaluation and management of pain in children with rheumatic diseases are still in the early stages of empirical development. Nevertheless, with the advent of the PPQ, systematic research efforts are now underway to develop the reliability and validity of the PPQ's measurement characteristics for pediatric rheumatic diseases. With these developments, the inclusion of pediatric pain measurement as an essential outcome variable in controlled clinical trials should be advocated. The major points to be advocated by professionals who care for these children are (1) Children can accurately report their pain when age-appropriate measures are used; (2) pharmacologic treatment is not a sufficient condition for adequate pain management; (3) cognitive-behavior therapy techniques can facilitate children's coping with "breakthrough" recurrent musculoskeletal pain with no known side effects; and (4) adequate pain control should be viewed as a quality assurance issue, considered as another indicator of the adequacy of pediatric health care.

Arthritis, Juvenile↗
PubMed1991

Effects of stress, social support, and self-esteem on depression in children with limb deficiencies.

Limb deficiencies in children are the result of trauma, disease, or congenital causes. The potentially negative impact on psychologic adjustment from the chronic strain of living with limb deficiencies appears to be mediated by perceived social support (interpersonal protective factor), microstressors and daily hassles (socioenvironmental risk factor), and self-esteem (intrapersonal protective factor). These risk and protective factors were simultaneously investigated as potential predictors of depressive symptomatology in 54 children with congenital or acquired limb deficiencies. Hierarchical multiple regression analyses were used to test the main effects and the interaction effects of the predictor variables on depressive symptomatology. None of the interaction terms were statistically significant. An overall simultaneous multiple regression analysis of the main effects model predicted 72% of the variance in depressive symptomatology, with perceived classmate social support emerging as the strongest predictor variable. The findings are discussed in terms of the risk and protective effects of mediating factors on the psychologic and social adaptation of chronically ill and handicapped children.

Adolescent↗
PubMed1991

Correlates of perceived physical appearance in children with congenital/acquired limb deficiencies.

Social support, daily hassles, marital discord, competence/adequacy, and psychological adjustment were investigated as hypothesized correlates of perceived physical appearance in 51 children with congenital or acquired limb deficiencies. Higher classmate, parent, and teacher social support were statistically predictive of higher perceived physical appearance. Higher daily hassles and marital discord were statistically predictive of lower perceived physical appearance. Higher peer acceptance, scholastic competence, and athletic competence were statistically predictive of higher perceived physical appearance. As a group, classmate, parent, and teacher social support, daily hassles, maternal and paternal perceived marital discord, peer acceptance, scholastic and athletic competence accounted for 78% of the variance in perceived physical appearance. Higher perceived physical appearance was in turn statistically predictive of lower depressive and anxious symptoms and higher general self-esteem. The findings are discussed in terms of the potentially modifiable predictors of perceived physical appearance and in terms of the role cosmetic differences play in psychological and social adaptation in children with visible physical handicaps.

Achievement↗