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Biomedical subjects

Robert B Noll

Publications and source records attributed to Robert B Noll.

At least 19 recordsLinked to original sources
PubMed2007

Intensity of CNS treatment for pediatric cancer: prediction of social outcomes in survivors.

PURPOSE: To evaluate the association of central nervous system (CNS) treatment intensity and the social functioning of children who have completed treatment for leukemia, lymphoma, and solid tumors outside the CNS. Furthermore, we expected that these associations would be moderated by child age at diagnosis and gender. METHOD: Peer, teacher, and self-report data were obtained for 82 cancer survivors (age 9-17 years) using classroom rating and nomination procedures that are widely used in research on social development. Information regarding cranial radiation therapy (CRT), intrathecal chemotherapy (ITC), and systemic methotrexate were obtained from medical records and used to create a composite index of CNS treatment intensity. RESULTS: Higher scores on the index of CNS treatment intensity were associated with poorer peer acceptance, fewer friendships, greater social sensitivity-isolation, and diminished leadership-popularity based on peer-report. These associations were stronger for boys and children who were younger (<10 years old) at diagnosis. In contrast, CNS treatment intensity was only predictive of teacher-perceptions of aggressive-disruptive behavior and it was unrelated to social self-perceptions. CONCLUSION: These results suggest that children who receive CRT and ITC are at risk for problematic peer relations, particularly if they are male or younger at diagnosis. Given the stability of poor peer relationships and documented linkages between peer problems and subsequent academic and psychiatric difficulties, clinical services should address these issues. Research is needed to identify mechanisms that account for these outcomes and provide direction for prevention and treatment efforts.

Adolescent↗
PubMed2006

Parent and family factors associated with child adjustment to pediatric cancer.

OBJECTIVE: To identify factors that influence the association between parent and child distress among families of children with cancer and comparison peers. METHODS: Parent and child distress, social support, and family environment were assessed among families of 95 children with cancer (94 mothers, 67 fathers) and 98 comparison peers (97 mothers, 77 fathers). RESULTS: Significant associations were found between parent and child distress. For models examining the impact of fathers' distress on children, several moderators were identified (i.e., family environment, child age and gender, a cancer diagnosis, and treatment severity). Family environment also partially mediated father and child distress. CONCLUSIONS: Children whose parents were distressed were more likely to be distressed themselves. Subgroups of children were particularly vulnerable, indicating a need to identify further mechanisms of risk and resilience and to develop family-based interventions. Support was found for including fathers as independent sources of information in pediatric psychology research and clinical practice.

Adaptation, Psychological↗
PubMed2006

Parent perceptions of nutritional issues during their child's treatment for cancer.

To examine family mealtime interactions, parental concerns about nutrition, and body mass index (BMI) among children with cancer who did not have primary central nervous system involvement. Parents of 95 children receiving treatment for cancer and 95 comparisons completed the About Your Child's Eating-Revised (AYCE-R) measure. Anthropometric data for children with cancer were obtained from medical charts at diagnosis and again when the AYCE-R was administered. No differences in mealtime interactions were found between children with cancer and comparisons, but parents of children with cancer reported greater concern about their child's weight. Anthropometric measures for children with cancer were consistent with national norms. However, children with cancer were somewhat underweight at diagnosis and became heavier over time. Lower BMI was associated with mother and father report of greater resistance from the child at mealtime, father report of his own aversion to family meals, and more severe treatment. The impact of cancer on family mealtime interactions and BMI appeared minimal during treatment. However, further longitudinal research is needed given the risk for late effects, such as growth problems and obesity, among cancer survivors. Families also may benefit from ongoing education to optimize healthy lifestyles among survivors.

Adolescent↗
PubMed2005

Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial.

Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n=213) or UPC plus 8 sessions of PSST (PSST; n=217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.

Adaptation, Psychological↗
PubMed2004

Communication of randomization in childhood leukemia trials.

CONTEXT: Most children diagnosed as having leukemia become research subjects in randomized clinical trials (RCTs), but little is known about how randomization is explained to or understood by parents. OBJECTIVE: To investigate physicians' explanation and parental understanding of randomization in childhood leukemia RCTs. DESIGN AND SETTING: A multisite study of the informed consent communication process for RCTs of childhood leukemia. Consecutive cases were recruited from pediatric oncology inpatient wards at 6 US children's hospitals associated with major academic medical centers from July 1, 1999, until December 31, 2001. The informed consent conferences were observed and audiotaped, and the information obtained was coded and analyzed. Parents were interviewed shortly after the conference to ascertain their understanding. PARTICIPANTS: Parents and members of the health care team who participated in 137 informed consent conferences for children with newly diagnosed acute leukemia. MAIN OUTCOME MEASURES: Observed explanations of randomization and parental understanding of randomization after the consent conference. RESULTS: Randomization was explained by physicians in 83% of cases and a consent document was presented during the conference in 95% of cases. Interviews after the conference demonstrated that 68 (50%) of 137 parents did not understand randomization. Parents of racial minority and lower socioeconomic status were less likely to understand randomization (P<.001 for each). Discussion of specific clinical trial details and the presence of a nurse during the conference were associated with understanding. Eighty-four percent of children were enrolled in a leukemia trial. CONCLUSIONS: Despite oral and written explanation, half of the parents in this study did not understand randomization for childhood leukemia trials. To make informed consent more effective, future research must seek to improve communication during this critical interchange.

Adolescent↗
PubMed2004

Commentary. Health and behavior CPT codes: an opportunity to revolutionize reimbursement in pediatric psychology.

Recently accepted codes in the Current Procedural Terminology system permit licensed pediatric psychologists to deliver psychological services utilizing billing codes that focus on improving medical and physical health. They potentially allow pediatric psychologists to obtain third-party reimbursement for services within a biopsychosocial model of care without requiring a concurrent psychiatric diagnosis. These codes represent a potential major paradigm shift whereby the services of a pediatric psychologist are provided and billed within the context of physical health care. Information is provided on the history of these codes along with detailed information regarding their utilization. Future directions for implementation, teaching, and research are provided along with a strong encouragement for use of these codes by pediatric psychologists.

Behavior Therapy↗
PubMed2004

Height and social adjustment: are extremes a cause for concern and action?

OBJECTIVE: Growth hormone treatment of hormone-sufficient short youths is predicated on the belief that short stature is associated with social problems with peers. This study assessed peer relations and social adjustment as a function of height in a community sample. METHODS: A cross-sectional study was conducted at 1 public school district in Western New York of students of both genders who attended grades 6 to 12 (N = 956). Target groups included participants of short stature (height or=1.6 standard deviation; >or=95th percentile; n = 58) and classmates of average height (between the 25th and 75th percentiles; n = 123) used for within-class comparisons. All remaining unclassified classmates (n = 704) also provided data. Self- and peer-rated assessment of social reputation and social acceptance was measured. RESULTS: Minimal effects of height on measures of social functioning were detected despite substantial statistical power. We detected no significant relationships between height and measures of friendship, popularity, or reputation with peers. Findings did not vary by gender of participant, by peer- or self-report, or by whether data from the entire sample were used or target groups were contrasted with comparison participants. Shorter students were perceived by peers to be younger than their age. This influence was restricted to lower grades and did not have an impact on measures of social acceptance or reputation with peers. CONCLUSIONS: Extremes of stature in the general population-either short or tall-have minimal detectable impact on peer perceptions of social behavior, friendship, or acceptance. Findings are not supportive of the need to intervene a priori because of the potential risk of negative stature-related social sequelae. Furthermore, if problems with peer relationships are identified among short or tall youths, then factors other than stature should be considered as etiologically important.

Adolescent↗
PubMed2004

Emotional, social, and behavioral functioning of children with sickle cell disease and comparison peers.

This research examined the emotional, social, and behavioral functioning of children with sickle cell disease (SCD) and classroom comparison peers from the perspective of primary and secondary caregivers. It was hypothesized that children with SCD would have more internalizing (emotional) and social problems and fewer externalizing (behavioral) problems than comparison peers. Caregivers of 70 children with SCD and 67 comparison peers completed the Child Behavior Checklist (CBCL) during visits to the children's homes. Relative to comparison peers, children with SCD were perceived by primary caregivers as having more total and internalizing problems and less total competence. Additionally, significantly more children with SCD exceeded clinical cutoffs on the CBCL. While caregivers of children with SCD perceive these children to be at a slightly elevated risk for problems across multiple domains, a significant number of children with SCD have problems in the clinical range. The authors recommend that vigorous screening programs for mental health problems should be included in the routine care of children with SCD, and programs of psychosocial intervention research should be implemented to ameliorate problems for the children at greatest risk.

Adolescent↗
PubMed2003

Behavioral reputation: a cross-age perspective.

This study examined the measurement of peer perceptions of behavioral reputation within the contexts of elementary, middle, and high school environments (Grades 2-12, N = 2,812) through the systematic evaluation of the psychometric properties of the Revised Class Play (A. S. Masten, P. Morison, & D. S. Pellegrini, 1985). Confirmatory factor analyses demonstrated that the data did not fit A. S. Masten et al.'s original 3-factor structure. Cross-loading of items and different patterns of association between subscales across age groups (elementary, middle, and high school) contributed to the overall poor fit. Exploratory factor analyses revealed an alternative 4-factor structure as a more reliable and valid means of assessing behavioral reputation regardless of the age of the peer group sampled. Both convergent and divergent patterns of associations emerged across developmental levels.

Adolescent↗
PubMed2003

Brief report: child-rearing practices of caregivers with and without a child with juvenile rheumatoid arthritis: perspectives of caregivers and professionals.

OBJECTIVE: To evaluate predictions from professionals in pediatric rheumatology regarding the child-rearing practices of caregivers of children with juvenile rheumatoid arthritis (JRA) and healthy classmates. METHODS: Sixteen professionals identified items from the Child-Rearing Practices Report (CRPR) that were expected to differentiate between caregivers of children with JRA (64 mothers, 45 fathers) and caregivers of healthy classmates (64 mothers, 40 fathers). Families were interviewed, and physician ratings of disease severity were obtained. RESULTS: Experts predicted difficulties in protectiveness, discipline, and worry. Ratings from parents of children with JRA showed modest agreement with the professionals, surprising similarity to controls, and a limited association with disease factors. CONCLUSIONS: Contrary to expert opinion, JRA has only a modest influence on some child-rearing practices. Educating health care providers may minimize misperceptions about caring for children with JRA, and screening parents of children with more severe disease may assist in allocating education and services for families.

Adolescent↗
PubMed2003

Social, emotional, and behavioral functioning of children with hemophilia.

This study examines the social, emotional, and behavioral functioning of children with hemophilia. Data were collected in the homes and schools of 40 boys with hemophilia and 40 comparison boys of the same race and age. Data on social, emotional, and behavioral functioning were collected from teachers, classmates, parents, and the participants. Children with hemophilia scored comparably with comparison peers in all areas of social functioning but reported more difficulties with emotional well-being, including more depressive symptomatology and lower self-perceptions. Parent report also indicated more difficulties with emotional well-being. Parents did not report significant differences in externalizing behavior problems. In conclusion, children with hemophilia were not found to be at increased risk of social or behavioral difficulties. However, both children with hemophilia and their parents identified more difficulties with emotional well-being. Nevertheless, approximately all mean scores for both groups remained within the normal range.

Case-Control Studies↗
PubMed2003

A controlled longitudinal study of the social functioning of children who completed treatment of cancer.

BACKGROUND: A follow-up assessment of social functioning was performed for children with cancer after completion of treatment. It was hypothesized that children who completed cancer treatment (CCT) would have more social problems than their peers who were not chronically ill (COMP) and that greater treatment intensity would be predictive of increasing social difficulties over time. PATIENTS AND METHODS: Peer, teacher, and self-reports of social functioning were obtained from 69 CCTs and 77 COMPs. Social reputation and social acceptance were evaluated cross-sectionally and longitudinally. RESULTS: Relative to COMPs, CCTs described themselves as more prosocial, were perceived by teachers as less aggressive, and were seen by peers as more sick, more tired, and as missing more school. Longitudinal analyses indicated that self-reported prosocial scores were significantly more stable over time for CCTs relative to COMPs. Children who received more intense treatment were perceived by peers as more prosocial and less aggressive, but as having fewer best friends 2 years after treatment ended. CONCLUSIONS: CCTs had minimal impact on their social functioning as a result of their experience with cancer for those children who have returned to school. These results suggest that routine interventions with regard to social functioning after treatment ends may not be warranted for most CCTs when an integrated program of psychosocial services coordinated by mental health professionals has been provided during treatment. However, children who have undergone especially intense treatment may be at some risk for social problems.

Adolescent↗
PubMed2002

Problem-solving skills training for mothers of children with newly diagnosed cancer: a randomized trial.

Mothers of children with serious illnesses have lower levels of well-being than mothers in the general population. Problem-solving therapy (PST), a cognitive-behavioral intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being. This report describes a problem-solving skills training (PSST) intervention, based on problem-solving therapy, for mothers of newly diagnosed pediatric cancer patients. Ninety-two mothers were randomly assigned to receive PSST or to receive standard psychosocial care (Control Group). After the 8-week intervention, mothers in the PSST Group had significantly enhanced problem-solving skills and significantly decreased negative affectivity compared with controls. Analysis revealed that changes in self-reports of problem-solving behaviors accounted for 40% of the difference in mood scores between the two groups. Interestingly, PSST had the greatest impact on improving constructive problem solving, whereas improvement in mood was most influenced by decreases in dysfunctional problem solving. The implications of these findings for refinement of the PSST intervention and for extension to other groups of children with serious illnesses are discussed.

Adaptation, Psychological↗