OBJECTIVE:The goal of this meta-analysis was to analyze whether children of parents with chronic physical health conditions exhibit larger levels of internalizing and externalizing problems, as well as total problem behavior, compared to children from families without these conditions and test norms. METHODS:A systematic search of the electronic databases PsycINFO, MEDLINE, Web of Science, and Google Scholar (completed on February 9, 2026) yielded 174 studies with 92,548 children that were included in a multilevel meta-analysis. Risk for bias was assessed with the Mixed Methods Appraisal Tool. The meta-analysis was preregistered at OSF (https://osf.io/awbqh). RESULTS:We found higher levels of internalizing (g = .29), externalizing (g = .20), and total problems (g = .28) in children of parents with chronic physical health conditions. For two outcomes, there were indications of a potential file-drawer problem. The highest levels were observed in families with parents experiencing chronic pain, and the weakest levels were found in families with parents who had cancer. The effect sizes were also stronger when the chronic conditions lasted longer, when the parents with chronic conditions were older, when the parents with chronic conditions were mothers or nonpartnered individuals, when the parents with chronic conditions rated child outcomes rather than their healthy partners, when the comparison was made with families without chronic conditions rather than with test norms, and in unpublished studies. CONCLUSION:Children of parents with chronic physical health conditions should be screened for emotional and behavioral problems, and they should receive prevention and intervention services according to their needs.
OBJECTIVE:Positive psychological constructs (e.g., benefit finding, resilience, and diabetes strengths) have been associated with greater engagement in self-management behaviors among teens with type 1 diabetes (T1D). However, for teens with T1D experiencing diabetes distress, these potentially protective associations are less understood. To explore the potential protective functions of positive psychological constructs, we investigated their associations with subjective and objective diabetes self-management behaviors and health outcomes among adolescents with diabetes distress. METHODS:This secondary analysis used baseline data from a two-site intervention trial among adolescents with T1D and elevated diabetes distress. Participants (n = 172, ages 12-18, M(SD) = 15.7(1.6) years; 56% female) completed validated measures of benefit finding, resilience, diabetes strengths, self-management behaviors, and health-related quality of life (HRQOL). Objective self-management was measured via continuous glucose monitor percent time active. Glycated hemoglobin A1c (HbA1c) (glycemic outcome) was collected via electronic health records or dried blood spots. Separate hierarchical linear regressions for each outcome were conducted controlling for demographic and medical covariates and diabetes distress. RESULTS:Positive psychological constructs explained additional variance in self-management beyond distress and demographic and medical covariates (ps < .05). Diabetes strengths consistently predicted self-management and HRQOL (ps < .05), whereas benefit finding and resilience showed limited associations; none of the positive constructs were associated with HbA1c. CONCLUSIONS:Given robust links with self-management and HRQOL, above and beyond diabetes distress, diabetes strengths and other positive psychological constructs may serve as resilience resources in adolescents with T1D. These findings suggest interventions targeting diabetes strengths may be promising to enhance engagement and HRQOL in this high-risk population.
OBJECTIVE:Adolescents with type 1 diabetes (T1D) frequently experience elevated diabetes distress, which is associated with poorer psychosocial and glycemic outcomes. Mindfulness-based intervention (MBI) and education programs may reduce distress through distinct mechanisms. This mixed-methods study examined adolescents' experiences of two group-based interventions to understand perceived benefits, mechanisms of change, and satisfaction in the context of diabetes distress trajectories. METHODS:Participants were N = 39 adolescents with T1D enrolled in a pilot randomized controlled trial comparing MBI to diabetes-focused health education. Adolescents completed the Problem Areas in Diabetes-Teen scale at baseline, post-intervention, and 3-month follow-up. Reliable Change Index criteria classified diabetes distress trajectories. Semi-structured post-intervention interviews (n = 37) were analyzed using reflexive thematic analysis. Quantitative and qualitative findings were integrated through joint display. RESULTS:Diabetes distress decreased from baseline to post-intervention (B = -11.01, SE = 2.87, p < .001) and remained lower at follow-up (B = -7.02, SE = 2.87, p = .017), with no group difference. Qualitative analyses identified three themes: (1) each intervention appeared to effectively target its respective core mechanism to reduce distress, (2) connecting with others with shared lived experiences was a powerful support for adolescents in both interventions, and (3) barriers to satisfaction centered on intervention content and group dynamics, and were more salient in MBI. CONCLUSIONS:MBI and diabetes-focused health education may reduce diabetes distress through distinct yet complementary mechanisms. Integrating adolescents' perspectives with outcome data underscores the importance of peer connection, engagement, and intervention tailoring to optimize psychosocial care for adolescents with T1D.
OBJECTIVE:The Problem Areas in Diabetes Child version (PAID-C) and Parent version (P-PAID-C) have demonstrated initial validity and reliability in research samples; however, little is known about their performance in routine clinical settings. This study evaluated the factor structure of the PAID-C and P-PAID-C using clinic-based screening data from school-aged children (aged 8-12 years) with type 1 diabetes (T1D) and their parents. METHODS:Children with T1D and their parents completed the PAID-C and P-PAID-C as part of standard clinic screening. We conducted confirmatory factor analyses using weighted least-squares mean and variance-adjusted estimation. We tested one-, two-, and four-factor models based on previous validation work and evaluated model fit using comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean squared residual. RESULTS:Across approximately 24 months, 371 children completed the PAID-C and 893 parents completed the P-PAID-C. For the PAID-C, the one- and two-factor models both showed acceptable fit, with the two-factor model demonstrating the best fit. For the P-PAID-C, only the four-factor model reached acceptable fit after we correlated two similar error terms. Child PAID-C scores did not correlate with glycated hemoglobin (HbA1c), while parent P-PAID-C scores showed a small positive association with child HbA1c and were higher among parents of Hispanic children. CONCLUSIONS:Findings support the structural validity of the PAID-C and P-PAID-C when used in real-world clinical care. Results confirm diabetes distress as a multidimensional construct and reinforce the clinical utility of these brief measures for identifying specific distress domains and informing tailored interventions for children with T1D and their caregivers.
OBJECTIVE:Community health workers (CHWs) are uniquely positioned to provide community-based, culturally responsive, and accessible healthcare to pediatric populations. We conducted a scoping review of the literature to describe how CHWs have been involved in pediatric health intervention research in the United States. METHODS:We searched the databases PubMed, PsycInfo, Medline, CINAHL, and Medic Latina for peer-reviewed intervention studies published in English from 2003 to 2025. Additional inclusion criteria were that CHWs were involved in some aspect of intervention delivery; the intervention impacted a child's physical, behavioral, or mental health concern or behavior; the study provided quantitative outcome data, and the intervention was implemented in the United States. We extracted information on (1) the characteristics of interventions CHWs have delivered, (2) the extent to which CHWs are providing interventions with psychotherapeutic content, (3) the training and supervision received by CHWs, and (4) the match between intervention components and CHW roles/competencies. RESULTS:We identified 11,361 articles from our search, of which 151 articles met inclusion criteria. Interventions addressed a range of pediatric health conditions and prevention/promotion outcomes, and 35 interventions included psychotherapeutic components. Most studies provided minimal information about CHW training and supervision, and CHWs' roles in most studies were limited to providing health education and outreach, despite the wide range of competencies CHWs have in providing care. CONCLUSIONS:We call for pediatric psychologists to advocate for CHWs as members of multidisciplinary healthcare teams and collaborate with CHWs in research and practice for children and families.
OBJECTIVE:The use of Item Response Theory for measure development has increased over the years. Components of Item Response Theory serve as the foundation for computerized adaptive tests and can be used to ensure equitable assessment through differential item functioning (DIF) analyses across proxies of intersectional positionality. The focus of this study is to confirm the three-factor structure of the Pediatric Symptom Checklist-17 (PSC-17) and to explore uniform and non-uniform DIF analyses of PSC-17 items among youth living with Type 1 diabetes, a population for which equitable and rapid assessment is essential. METHODS:Data were drawn from 184 caregiver-youth dyads in the PRYDE sample who completed the 17-item version of the PSC. Youth identified as "Female" (50%), "Male" (50%), Black/AA (56%), and White (43%). Youth ages ranged from 12 to 18 years (M = 14.64, SD = 1.70). Participants' most recent HbA1c was obtained from their medical records. RESULTS:Model fit indices for the initial confirmatory factor analyses of the PSC-17 were acceptable. Evidence for retaining the three-factor model of the PSC-17 was confirmed. Finally, there was no significant uniform or non-uniform DIF present for any of the variables evaluated. CONCLUSIONS:These findings provide some preliminary evidence of non-DIF, suggesting that the PSC-17 may be meaningfully free of biases for our sample.
OBJECTIVE:Neighborhood context is a critical determinant of child health; yet, few studies have examined how neighborhood opportunity relates to a range of health behaviors and indicators-including sleep, physical activity, body composition, grip strength, lung function-during middle childhood, a key period for shaping long-term health. This study addressed this gap by using the Child Opportunity Index to assess whether neighborhood opportunity was associated with child physical health and whether associations differed by birth-assigned sex. METHODS:Participants included 710 racially and socioeconomically diverse twin children (Mage = 8.43 years, SD = 0.68; 51.5% female; 58.5% Non-Hispanic White; 23.7% Hispanic) living in urban and rural areas across Arizona. Neighborhood opportunity was assessed using the Child Opportunity Index 2.0 based on participants' census tracts. Children wore actigraphy watches for 7 days and nights (M = 6.81, SD = .67) to capture sleep and physical activity. Body composition, grip strength, and lung function measurements were collected during home visits. RESULTS:Structural equation modeling showed that higher neighborhood opportunity predicted earlier and less variable sleep midpoint, longer sleep duration, greater grip strength, and higher lung peak expiratory flow in boys and lower sleep midpoint variability and higher lung forced expiratory volume in girls. No significant associations were found between neighborhood opportunity and physical activity or body composition. CONCLUSIONS:Neighborhood opportunity was associated with multiple indicators of physical health, underscoring the broader role of neighborhood environments in shaping children's development. Boys and girls may experience or respond to these environmental contexts differently, highlighting the importance of considering sex in neighborhood health research.
OBJECTIVE:"Grit" is a personality construct defined as the tendency to work toward long-term goals and may influence chronic disease management behaviors in type 1 diabetes. We sought to determine whether adolescent and caregiver grit are associated with hemoglobin A1c in adolescents with type 1 diabetes. We also evaluated the relationship between adolescent and caregiver self-control, another construct already explored in type 1 diabetes, with hemoglobin A1c to determine whether similar patterns of association are observed. METHODS:We performed a single-center, cross-sectional study of 114 adolescents with type 1 diabetes and their primary diabetes caregiver. Patients were English-speaking, 13-15 years old, and had diabetes for ≥2 years. Using unadjusted and adjusted regression models, we examined the relationship between adolescent and caregiver grit and hemoglobin A1c. Unadjusted and adjusted effect estimates are also reported for adolescent and caregiver self-control with hemoglobin A1c. RESULTS:After confounding adjustment, higher adolescent grit was associated with a lower hemoglobin A1c (B = -0.5% [-0.8 to -0.2] or -5 mmol/mol [-9 to -2]). Caregiver grit was not associated with adolescent hemoglobin A1c. We observed similar associations between self-control and hemoglobin A1c. CONCLUSIONS:To our knowledge, this is the first study to examine the relationship between grit and hemoglobin A1c among adolescents with type 1 diabetes. Adolescents with more grit had lower hemoglobin A1c values than those with less grit. These findings suggest that longitudinal studies to evaluate this association further are warranted. Trials testing the efficacy of behavioral interventions to augment grit and improve glycemic stability can then follow.
OBJECTIVE:This study examined the mediating effect of perceived physical appearance on the association between disability and psychopathology in youth with chronic physical illness, and whether effects differed by sex. METHODS:A cohort of 263 children and youth (2-16 years at enrollment) diagnosed with a chronic physical illness were recruited from a Canadian pediatric hospital. Data from 102 youth aged ≥ 10 years who were eligible to provide self-reports (n = 50 female; n = 52 male) were analyzed. Youth psychopathology (emotional, behavioral, and attentional symptoms) was measured using the Emotional Behavioural Scales-Brief Version, and disability was measured using the WHO Disability Assessment Schedule 2.0. Multiple-group path analysis was used to investigate the direct and indirect effects between youth disability and psychopathology, mediated by perceived physical appearance for male and female youth over a 24-month period. RESULTS:For both male and female youth, elevated disability was directly associated with lower perceptions of physical appearance (βmale = -0.26 [0.11], βfemale = -0.20 [0.08]) and elevated symptoms of behavioral (βmale = 0.35 [0.10], βfemale = 0.29 [0.09]) and attentional symptoms (βmale = 0.31 [0.10], βfemale = 0.24 [0.09]). Perceived physical appearance mediated the relationship between disability and emotional symptoms for males (αβ = 0.11 [0.01-0.21]). CONCLUSIONS:The level of disability is a key factor influencing the mental health of youth with chronic physical illness, and the mechanism by which its effects are exerted differs by sex. More comprehensive multiple-mediator models that consider potential bidirectional associations are warranted.
OBJECTIVE:This study examines associations between geocoded neighborhood conditions and health, neurocognitive, and academic outcomes among youth with spina bifida (SB). METHODS:Addresses of youth with SB living in the Midwest (N = 130, Mage= 11.5 ± 2.5; 53.8% female; 51.5% non-Hispanic White) were geocoded based on census tracts and linked to state-normed Child Opportunity Index (COI) scores. Youth completed performance-based measures of attention, intelligence, working memory, cognitive flexibility, and academic achievement. Parents and teachers completed standardized questionnaires assessing attention, executive functioning, academic achievement, and academic competence. Parents also reported health complications (e.g., shunt revisions, urinary tract infections). Regression analyses controlled for age and lesion level. RESULTS:COI scores were significantly and positively associated with youth attention, working memory, intelligence, cognitive flexibility and academic achievement, but not with health complications or inhibition. CONCLUSIONS:Neighborhood factors were significantly associated with several neurocognitive and academic subdomains in youth with SB. These results highlight the importance of devoting resources to better serve youth with SB living in lower-opportunity neighborhoods and can be used to support systems and policies driving equitable outcomes for these youth.
OBJECTIVE:Provide an overview of medical traumatic stress in pediatric critical care and highlight pediatric psychology as a central mechanism for translating evidence into trauma-informed screening, prevention, and intervention practices within pediatric intensive care units (PICUs). METHODS:Current literature is synthesized to characterize medical traumatic stress, identify trauma-informed practice guidelines, and propose recommendations for improved integration of pediatric psychology into critical care settings. RESULTS:High rates of medical traumatic stress and posttraumatic stress disorder (PTSD) are reported among critically ill children, caregivers, and PICU staff, with identifiable risk factors. Current and emerging standards of care reviewed include traumatic stress and delirium screening, early mobility initiatives, PICU follow-up programs, trauma-focused interventions, and staff debriefing efforts. CONCLUSIONS:Medical traumatic stress is a common outcome of PICU hospitalization. Earlier integration of pediatric psychology services during and following PICU admission offers promise for improving outcomes, advancing trauma-informed care, and informing future research across the PICU continuum.
OBJECTIVE:Children who spend time in foster care are at risk for adverse developmental outcomes, including sleep problems. Yet, research examining sleep and emotional memory has primarily focused on children with no history of foster care placement. Additionally, most accounts of sleep problems among children with a foster care history rely on caregiver-report rather than objective measures. This study examined emotional memory and sleep using both objective and subjective reports. METHODS:Participants included 3- to 5-year-old children who were adopted from foster care in the U.S. (n = 32) and a community sample of children with no foster care history (n = 35). Sleep was assessed using actigraphy and questionnaires (Children's Sleep Habits Questionnaire [CSHQ] and the Parent-Child Sleep Interactions Scale [PSIS]). Caregivers also completed the Adverse Childhood Experiences questionnaire (ACEs). Emotional memory was assessed with an emotional story task in the evening before overnight sleep and the following morning. RESULTS:As predicted, the adopted sample had worse objectively measured sleep quality, with higher wake after sleep onset, lower sleep efficiency, and earlier waketimes. Additionally, adopted children scored higher on the CSHQ Parasomnias subscale which was associated with a greater number of ACEs. Adoptive parents also reported providing more frequent reassurance at bedtime and reinforcement of positive sleep behaviors, as measured by the PSIS, compared to the community sample. Performance on the emotional story task did not differ significantly between the groups. CONCLUSIONS:These results reinforce that children with a history of foster care placement have worse sleep and are more prone to parasomnias even after adoption. Trauma-informed sleep interventions may be most effective in resolving sleep problems in these children.
