Clinical Practice in Pediatric Psychology

To develop a digitally enabled adherence platform (DEAP) using evidence-based adherence promotion strategies through iterative testing with patients, design specialists, and adherence experts.

Adolescents and young adults (AYAs) with a kidney transplant from a large, midwestern transplant program were recruited to participate in this study. Through an iterative process, we conducted focus groups, individual interviews, empathy interviews/mapping, and usability testing and evaluation to develop and refine the initial version of DEAP.

Three empathy maps were created to assess the unique needs of patients, caregivers, and healthcare providers. Eleven patients were then recruited to participate in usability testing of the platform. Platform engagement was high with nine of the 11 participants viewing their initial messages/surveys, usability was rated as high (M = 81.88, SD = 9.61, range = 67.5–95.0), and user-friendliness was rated as excellent (M = 5.88, SD = 0.74, range = 5.0–7.0). Participants also noted multiple opportunities for improving the look and design of DEAP.

Engaging with multiple stakeholders and piloting a small usability study have demonstrated support for the acceptability and usability of DEAP, a mobile health platform to address barriers to taking immunosuppression medication for AYAs who have received kidney transplants. Future work is planned to develop a better patient and clinician user experience, increase personalization, and facilitate patient–clinician engagement using this platform.

Up to 40% of adolescents and young adults (AYAs) who have undergone kidney transplants do not take their immunosuppression medication as prescribed, which can lead to devastating consequences including organ rejection. DEAP (digitally enabled adherence platform), a web-based system, was designed using an iterative process with input from key stakeholders with features to assess adherence barriers and provide solutions through problem-solving. Preliminary usability testing suggests it is acceptable and easy to use, demonstrating its potential to address suboptimal adherence and improve health outcomes.

Behavioral parent training programs show clear efficacy and effectiveness in response to young children’s disruptive behavior problems, but limitations in engagement and accessibility prevent many families from benefiting from these programs. The Parenting Young Children Check-up (PYCC) is a technology-based program designed to overcome these barriers and increase the reach of behavioral parent training. Developed for use in pediatric primary care, the PYCC includes three components: (a) an initial check-up designed to motivate program involvement; (b) text messages to connect parents with program content and reinforce content; and (c) a parent training website involving video-based content to teach parenting skills. This report details initial steps to refine PYCC intervention components.

Seventeen mothers and 17 primary care physicians participated in this mixed methods data collection across three iterations by providing feedback on early drafts of the three components of the PYCC and completing a feedback questionnaire.

Feedback from one iteration informed modifications that were then evaluated in subsequent iterations. Saturation of qualitative input, positive qualitative feedback, and positive quantitative ratings on the feedback questionnaire was achieved in iteration three.

Outcomes of this investigation informed the full version of the PYCC that will subsequently be tested in a proof-of-concept trial.

Several barriers limit the reach of parenting skills programs that reduce child problem behavior. We gathered feedback from parents and physicians to refine a parenting program that uses technology and delivery in pediatrics to overcome barriers. Future testing of the program will further inform implementation in pediatric settings.

Despite a marked increase in the prevalence of pediatric immunoglobulin E-mediated food allergy (FA) in recent decades, there is a dearth of age-appropriate management education and support tools for youth with FA. The purpose of this report is to detail our methods for intervention design and refinement of an interactive educational software program for school-aged children with FA.

Development of the “Friends, Family, and Food Application (F3-App)” employed an iterative, user-centered design approach with input from children with FA, their caregivers, and other key experts. Phase 1 (prototype development/pilot evaluation) involved family input on key themes and educational messages, development of a prototype, and pilot testing. Phase 2 (full F3-App development/open trial) included refinement and expansion of the prototype per advisory panel and end-user recommendations, followed by an open trial with additional iterative refinement.

Acceptability and credibility of the F3-App were rated highly by most participants. Relatively few technical challenges arose with F3-App installation or use. Follow-up interviews with children and caregivers suggested that the F3-App was generally well received, families found the content useful, and that it prompted family discussion about the child’s FA management.

User input is critical to developing family-friendly software to support management of pediatric chronic conditions. Interactive educational software can be a useful channel for children to practice skills and build confidence in disease self-management and to facilitate family communication regarding the stresses of FA management.

This study describes the development of the Friends, Family, and Food Application (F3-App), with a focus on the community partner-driven design process. The F3-App was credible and highly accepted and recommended by families and promoted family communication around food allergy management. The F3-App that was developed was used in a subsequent randomized, controlled trial.

This study assessed the feasibility and acceptability of two types of innovative approaches, namely biofeedback-assisted relaxation in virtual reality ([VR]-delivered biofeedback) and yoga in the management of pediatric headaches. The secondary aim was to evaluate the preliminary efficacy of both interventions.

Children were randomized to three conditions: waiting list, yoga, and VR-delivered biofeedback. Feasibility was assessed by applicability to the pain problem, and acceptability by attendance (missed sessions, dropout rate) and the use of learned strategies in everyday life. Preliminary efficacy was evaluated with questionnaires: frequency of headaches, functional disabilities, pain anxiety, and pain catastrophizing. Mean scale scores postintervention and two months afterward were compared with the baseline with repeated-measures analyses of variance and contrast analyses.

A total of 46 children were enrolled; 39 completed the questionnaires at the baseline and participated in interventions. Regarding feasibility, the safety of the interventions seems demonstrated by the absence or infrequency of headaches during sessions. Regarding acceptability, compliance with the sessions was excellent for VR-delivered biofeedback condition and satisfactory for yoga. Most of the children reported using the strategies learned in daily life, even after the interventions. Regarding efficacy, participants reported significantly fewer headaches and functional disabilities postintervention and 2 months later. Minimal or no effects were observed on pain anxiety and pain catastrophizing.

This pilot study indicates that VR-delivered biofeedback and yoga exercises may be feasible and acceptable interventions for the treatment of pediatric headaches.

This study evaluates the feasibility and preliminary efficacy of two innovative interventions for pediatric headaches: virtual reality-delivered biofeedback and yoga exercises. The findings indicate that these interventions are feasible and applicable (good attendance, limited or no discomfort, and positive evaluation) and show preliminary efficacy (improvements in frequency of headaches and functional disabilities).

Chronic pain often clusters in families with up to 50% of parents of youth with chronic pain having chronic pain themselves. Interventions for pediatric chronic pain often involve parents, yet parental chronic pain and stress are rarely addressed. Acceptance and commitment therapy (ACT)-based interventions are efficacious for adult chronic pain, making it a potentially well-suited intervention for parents of youth with chronic pain who also have pain and/or mental health issues. In collaboration with patient partners, we developed and tested feasibility and acceptability of a pilot ACT-based virtual intervention focused on parental chronic pain and mental health.

Parents of youth with chronic pain who had chronic pain participated in four 1.5-hr weekly sessions delivered virtually. Parents completed pre- and posttreatment measures of pain and mental health symptoms. Feasibility was assessed using session attendance. Parents rated intervention acceptability and provided feedback at the end of the study.

Six parents (four mothers, M_age = 45.5 years) attended at least three out of four sessions. Parents rated the intervention to be acceptable (M = 56.7/70). Parents highlighted the sense of community and changes they observed in themselves.

The brief virtual ACT-based intervention for parents living with chronic pain was feasible and acceptable. Future clinical trials are warranted to assess the intervention efficacy to improve parental and youth outcomes.

Interventions for pediatric chronic pain often involve parents, yet parental chronic pain and stress are rarely addressed. We developed a brief virtual acceptance and commitment therapy-based intervention for parents of youth with chronic pain who have pain themselves. The intervention was feasible and acceptable.

Continuous glucose monitoring (CGM) systems can improve psychosocial and health outcomes among youth with type 1 diabetes (T1D). However, inconsistent use of CGM is common in youth and negates the clinical benefits of these devices. The current study sought to identify individual-, family-, community- and health care system-level predictors of greater CGM use in adolescents with T1D.

Adolescents with T1D (n = 66), ages 12–18 years, participated in a 3-month, prospective, observational study. Participants completed self-report questionnaires at baseline measuring individual (self-efficacy to manage T1D), family (collaborative parent involvement), community (diabetes-specific social support from friends), and health care system (insurance) predictor variables. Data on CGM use (i.e., number of days adolescents wore their CGM ≥ 12 hr) were collected monthly. Generalized linear mixed-effects models were used to examine associations between predictor variables and CGM use over time.

Adolescents (53% male, 83% white) averaged 15.03 years old (SD = 1.72 years), had an average glycated hemoglobin of 8.18% (SD = 1.89%), and used their CGM an average of 18.89 days each month (SD = 11.31). Self-efficacy to manage T1D was positively associated with CGM use (rate ratio = 1.21, p = .03). Collaborative parent involvement, diabetes-specific social support from friends, and type of insurance were not associated with CGM use.

Greater self-efficacy predicted more CGM use. Interventions that bolster diabetes self-efficacy may help promote consistent CGM use. Future research should continue to examine predictors of CGM use from family, community, and health care system domains.

Results from this study suggest that improving adolescents’ self-efficacy in their ability to manage their diabetes can help them use continuous glucose monitoring (CGM) more consistently. Interventions that bolster self-efficacy, including diabetes self-management education and coping skills training, may help adolescents who are struggling to use CGM more consistently. More research is needed to understand how family, community, and health care system variables affect CGM use.

This retrospective study aimed to analyze the practicality of conducting teleneurodevelopmental evaluations with a general clinical population of children under 5 years of age. The project goal was to afford continued clinical care during the height of the COVID-19 pandemic.

The study sample included children who required neonatal intensive care hospitalization after birth, given increased risk for developmental delay. The practicality and usefulness of a modified developmental evaluation administered via telehealth were analyzed. Evaluation results indicated whether patients were largely performing within expectations for age (i.e., pass) or if performance was below expectations indicating concern for developmental delay (i.e., fail).

Thirty-five out of a total of 51 patients had in-person evaluation transitioned to telehealth. No significant associations were found between gender, age at the time of testing, and evaluation accessibility. There was a significant association between gender and prior history of developmental delay. No other significant associations were found based on gestational age and birth weight. Concern for developmental delay was identified in 29% of evaluations. Intervention supports, including a combination of feeding therapy, medication/behavioral intervention, and speech–language therapy, were recommended for 46% of the patients identified with concern for developmental delay.

Telehealth developmental evaluation was practical and useful for patients, met clinical needs, and limited delay in accessing early intervention supports.

Approximately 250 million children across the globe aged 5 and younger are at heightened risk for delayed developmental milestones. Early detection, prevention, and intervention are crucial for optimizing academic, economic, and health outcomes for these children. Determining the practicality and usefulness of providing neurodevelopmental evaluations via telehealth provides important information as to alternative service delivery options for clinical care of young children. Conducting preliminary neurodevelopmental evaluations via telehealth with the option for further intervention if deemed necessary allows services to be more widely available to those who face undue burden attending in-person consultations.

Children and adolescents with epilepsy are at increased risk for a number of comorbidities which can affect their health-related quality of life. We aimed to leverage data collected through widespread, automated distribution of the PedsQL—epilepsy module (Modi et al., 2017) to patient caregivers in order to assess the feasibility of using the PedsQL to create a formalized psychosocial screening program.

Our team utilized quality improvement methodology to establish a clinic workflow and trial a psychosocial screening program based on targeting specific domains of the PedsQL—epilepsy module using existing cutoff scores.

In our sample, 58% (n = 67) of patients screened positive on one or more of the three targets PedsQL—epilepsy module domains based on parent reports. Approximately 40% of those were seen for a consult (n = 26). Consults most often involved psychoeducation related to the special education process or brief intervention for managing behavioral or mood concerns (76.9% of children who screened positive, n = 20).

The existing PedsQL—epilepsy module cutoff scores demonstrated utility in targeting patients for intervention in our high-volume multidisciplinary pediatric epilepsy clinic.

This article demonstrates the feasibility of using the PedsQL—epilepsy module in order to screen for psychosocial concerns in a busy pediatric epilepsy clinic. Valuable details including the process for developing and refining the screening process are also included.

Physicians in integrated primary care settings often refer siblings to the same pediatric psychologist. The objective of this article is to assist psychologists in ethical decision making regarding such referrals, which, if accepted, mean entering multiple relationships.

Ethical issues related to sibling referrals, including risk for harm and ways to avoid it, as well as potential benefits, are discussed in the context of the APA’s Ethics Code and relevant literature.

An ethical decision-making framework for evaluating sibling referrals is applied to case examples.

Pediatric psychologists must thoughtfully evaluate sibling referrals to identify when accepting sibling referrals is a reasonable risk. Use of a framework can facilitate decision making.

When pediatric psychologists provide individual therapy to more than one child from the same family, there are ethical risks. However, having siblings receive services from the same psychologist is efficient and improves access to care. This article reviews ethical risks and benefits of providing individual therapy to siblings and proposes a decision-making framework to aid pediatric psychologists in deciding how to proceed given sibling referrals.