OBJECTIVES:Anxiety disorders affect 20%-50% of youth with chronic medical conditions (CMCs) and can interfere with medical care and treatment outcomes. Psychological therapies are typically designed for youth without CMCs; thus, this systematic review (Open Science Framework preregistration osf.io/a52nd/) assesses the effect of psychological therapies on anxiety, functional impairment and health-related quality of life (HRQOL) in this unique population. METHODS:We included randomized controlled trials of psychological therapies vs. any comparator for youth (ages 24 and younger) with CMCs that assessed child anxiety. We excluded studies of adults and those not in English. Medline, Embase, PsycInfo, and CENTRAL databases were searched, studies were screened using COVIDENCE software, and meta-analysis was undertaken in R. Study quality was assessed using the Cochrane Risk of Bias tool, version 2. Quality of evidence was assessed using the GRADE system. RESULTS:Thirty-three studies with 2676 participants (ages 5-21 years) were included in the meta-analysis. Nearly all had at least some risk of bias. Overall, psychological interventions resulted in lower anxiety (Hedges' g = -0.48 [-0.71; -0.25]), but did not have a significant effect on functional impairment or HRQOL. Based on the GRADE criteria, we have moderate confidence in these results. Treatments with higher risk of bias and those with live therapist components had greater effects on anxiety. CONCLUSIONS:Psychological interventions may be effective for improving anxiety for children and youth with CMCs, particularly those with a live therapist. More high-quality studies are needed to understand what components produce the best outcomes for patients.

ObjectivesThis study explored how the COVID-19 pandemic impacted emerging adults. Previous COVID-19 research with this age demographic has focused on specific facets of life transitions (e.g., academic or economic stress) but does not consider the interrelatedness of these life domains. This project fills this gap by allowing participants to report on any aspects of their life to better understand frequent challenges with and experiences that may have helped with managing “the new normal” of the COVID-19 pandemic amidst typical transitions of emerging adulthood.MethodsQualitative and quantitative data gathered in July 2020 (n = 145) and January 2021 (n = 143) as part of a longitudinal study of emerging adults (18–24 years) who were enrolled at a Midwestern United States University at baseline were analyzed to explore impacts of COVID-19, particularly in relation to stress.ResultsQualitative results demonstrate a range of negative COVID-19 effects, including health challenges and relationship strain. Interestingly, positive effects were also reported, including allocating more time for hobbies and spending quality time with loved ones. Quantitative findings indicate that COVID-19 distress did not increase over time, but perceived exposure to pandemic effects significantly increased. A general perceived distress measure demonstrated a slight decrease in distress over time, suggesting a potential adjustment to ‘the new normal.’DiscussionCOVID-19 impacted multiple domains of typical developmental transitions for many emerging adults in our sample. Individual qualitative reports demonstrate uniquely personal impacts of COVID-19, while thematic trends appear across responses (e.g., relationship strain). Health care providers must consider how these impacts influence the wellbeing of emerging adults with whom they work as the pandemic continues to evolve.

Objectives: Hypermobile Ehlers-Danlos Syndrome (hEDS) is a heritable connective tissue disorder that results in physical symptoms, psychosocial challenges, and functional disability. Children with hEDS and their caregivers face challenges in managing the symptoms and associated impacts of the syndrome. Method: Mixed methods were utilized to allow children with hEDS and their caregivers to share challenges faced, effective coping strategies, and their readiness to engage in a self-management approach to treatment. As caregivers are frequently proxy reporters for their child's experience, concordance between caregiver and child was assessed for each variable. Additionally, child outcomes were assessed in relation to caregiver-child concordance on readiness to engage in self-management. Results: Results suggest moderate concordance across dyads, with many dyads agreeing on the challenges presented by the physical consequences of hEDS but differing on beliefs regarding coping. There were small effect sizes indicating better child psychosocial functioning when dyads were concordant on readiness to engage in self-management. Conclusion: When making treatment recommendations, practitioners should consider differences and similarities between caregivers and children's reported experiences with and beliefs about hEDS. Further, practitioner facilitation of family concordance on beliefs about hEDS may result in better outcomes for the child.

Hypermobile Ehlers-Danlos syndrome (hEDS) includes physical symptoms of chronic pain, fatigue, gastrointestinal dysfunction, and joint subluxations/dislocations. This study aims to fill a research gap regarding the psychosocial well-being in pediatric hEDS by assessing relationships between functional disability, social support, and mental health. Increased functional disability is hypothesized to be associated with increased mental health challenges, specifically anxiety and depression, and general social support is hypothesized to moderate this relationship, such that higher perceived social support will mitigate the negative psychological impacts of functional disability. Gender's influence on mental health in pediatric hEDS is also explored. Thirty-four youth with pediatric hEDS recruited from a United States Midwest multidisciplinary genetics clinic completed self-report questionnaires. Results demonstrate associations between functional disability and mental health, and social support and mental health independently; however, moderation was not found. Functional disability and social support each have a unique influence on the mental health of children with pediatric hEDS and should each receive clinical attention. Exploratory analyses into the influence of gender provide a groundwork for future studies.

Mobile health (mHealth) apps have the potential to enhance pain management through the use of daily diaries, medication and appointment reminders, education, and facilitating communication between patients and providers. Although many pain management apps exist, the extent to which these apps use evidence-based behavior change techniques (BCTs) remains largely unknown, making it nearly impossible for providers to recommend apps with evidence-based strategies. This study systematically evaluated commercially available pain management apps for evidence-based BCTs and app quality. Pain management apps were identified using the search terms "pain" and "pain management" in the App and Google Play stores. Reviewed apps were specific to pain management, in English, for patients, and free. A total of 28 apps were coded using the taxonomy of BCTs. App quality was assessed using the Mobile App Rating Scale. Apps included 2 to 15 BCTs (M = 7.36) and 1 to 8 (M = 4.21) pain management-specific BCTs. Prompt intention formation, instruction, behavioral-health link, consequences, feedback, and self-monitoring were the most common BCTs used in the reviewed apps. App quality from the Mobile App Rating Scale ranged from 2.27 to 4.54 (M = 3.65) out of a possible 5, with higher scores indicating better quality. PainScale followed by Migraine Buddy demonstrated the highest number of overall and pain management BCTs as well as good quality scores. Although existing apps should be assessed through randomized controlled trials and future apps should include capabilities for electronic medical record integration, current pain management apps often use evidence-based pain management BCTs.