IntroductionCancer pain remains a significant burden among children with cancer, and many patients experience pain starting around the time of diagnosis and throughout the course of treatment. A biopsychosocial treatment approach has been recommended to improve pain management in this population; however, specific psychosocial factors that contribute to pain in the early phases of pediatric cancer treatment have yet to be identified. The purpose of this study was to explore the biopsychosocial factors associated with pain experiences during the early phases of pediatric cancer treatment, with the goal of identifying children who may be at the highest risk for pain to inform future intervention and prevention efforts.MethodsData were collected from 203 children with cancer (M = 12.3 years of age, 53.2% male, 41.4% White, 26.6% Latino) and their primary caregiver within the first several weeks of treatment (M = 10 weeks). Children completed self-report questionnaires and caregivers completed self- and parent-proxy questionnaires at baseline. Cancer-related data, including diagnosis and date of diagnosis, were abstracted from the child's electronic medical record. Multiple regression analysis was used to examine associations between biopsychosocial risk factors, pain intensity, and pain interference.ResultsOlder age, female gender, and elevated depressive symptoms, fatigue, and child self-reported pain catastrophizing were significantly associated with increased pain intensity. Additionally, lower annual income, decreased physical functioning, and greater fatigue, child pain catastrophizing, and parent stress were significantly associated with increased pain interference.DiscussionFindings underscore the importance of utilizing a comprehensive biopsychosocial approach to pain assessment and management in pediatric oncology. This approach highlights the need for targeted interventions that address not only the physical aspects of pain but also the psychological and social contexts of patients, ensuring a more holistic and effective treatment strategy.

OBJECTIVE:To examine the longitudinal relationship between the use of religious and existential coping strategies on future psychological growth and distress among youth with a history of cancer and matched peers without cancer. METHOD:Participants (n = 294; cancer history = 179; no cancer history = 115) were aged 8-17 years at time of study enrollment. Participants completed assessments of religious and existential coping 3 years from baseline assessment, and assessments of psychological stress and growth 5 years from baseline assessment. Regression analyses examined medical, sociodemographic, and religious and existential coping factors associated with assessments of psychological stress and growth. The moderating roles of religious and existential coping on the relationship between group membership (i.e. those with/without cancer history) and psychological distress and growth were explored. RESULTS:A significant interaction effect was observed for psychological distress which indicated non-cancer comparisons, but not youth with cancer, reported greater psychological distress at year 5 when low levels of existential coping were reported at year 3. Additionally, a significant interaction effect was observed for psychological growth which indicated youth with cancer, but not non-cancer comparisons, reported greater psychological growth at year 5 when high levels of religious coping were reported at year 3. CONCLUSION:Results highlight religious coping was associated with greater psychological growth but not distress among youth with cancer, and suggest clinicians should aim to treat patient's spirituality with cultural humility and find ways to incorporate aspects of patient's spirituality into evidence-based behavioral health treatments.

BACKGROUND:Medication adherence is vital for optimal outcomes following pediatric allogeneic hematopoietic cell transplant (HCT), but current assessment methods have limitations. Cyclosporine (CSA), an immunosuppressive drug used post-HCT, is routinely monitored in post-transplant care. Variability in CSA blood levels has been linked to adherence in other pediatric populations, and the medication level variability index (MLVI) has shown strong associations with adherence behaviors. However, its utility in assessing CSA adherence post-HCT has not been explored. This study aimed to evaluate CSA blood level variability as an objective measure of adherence and establish MLVI as a predictor of disease-related outcomes in pediatric HCT recipients. PURPOSE:To investigate the utility of CSA blood level variability as a measure of medication adherence and the MLVI as a predictor of graft versus host disease (GVHD) in pediatric HCT recipients. METHOD:Medical and adherence data were collected from 127 children within 90 days post-discharge. Regression analyses assessed relationships between oral CSA adherence, CSA MLVI, and the incidence and grade of acute and chronic GVHD. RESULTS:Greater oral CSA adherence significantly predicted increased incidence (Est. = .008, P = .001) and severity of chronic GVHD (Est. = .006, P = .023), as well as greater severity of acute GVHD (Est. = .006, P = .002). Adherence did not predict acute GVHD incidence. Higher adherence variability was associated with increased MLVI (Est. = .225, P < .001) and greater severity of both acute (Est. = .004, P = .004) and chronic GVHD (Est. = .014, P < .001), but not their incidence. Greater MLVI significantly predicted increased incidence and severity of both acute (incidence: Est. = .005, P = .001; severity: Est. = .004, P = .002) and chronic GVHD (incidence: Est. = .004, P < .001; severity: Est. = .007, P < .001). CONCLUSIONS:Inconsistent CSA adherence significantly predicted higher CSA MLVI, which was linked to increased GVHD incidence and severity. These findings highlight the potential of MLVI as a reliable adherence measure and the importance of ongoing adherence support in pediatric HCT care.

Introduction: Assessment of health-related quality of life (HRQOL) provides crucial information for evaluating the benefits of treatments such as hematopoietic cell transplantation (HCT) for individuals with sickle cell disease (SCD). Caring for a child with SCD, especially one undergoing HCT, can significantly impact caregiver HRQOL and parental functioning, which in turn can be an important determinant of child HRQOL. Few studies have examined HRQOL in children and young adults with SCD undergoing HCT as well as their caregivers. We aimed to examine patient HRQOL, caregiver proxy report of HRQOL, and caregiver HRQOL before and after HCT for SCD. Methods: Children and young adults with SCD ages 8-23 received either a matched sibling donor (MSD) or a haploidentical donor (HAPLO) HCT following reduced toxicity conditioning with alemtuzumab, thiotepa and low dose total body irradiation (NCT04362293). Sirolimus was used for graft-vs-host-disease prophylaxis for 6-12 months post-HCT in all patients, with additional post-transplant cyclophosphamide in patients with HAPLO donors. Patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures, with lower scores indicating improvement for Anxiety, Depression, Pain Interference, Pain Behavior, Sleep Disturbance, and Fatigue, and higher scores indicating improvement for Physical Function, Life Satisfaction, Positive Affect, Peer Relationships, and Family Relationships. Caregivers completed PROMIS proxy measures in the same domains except Pain Behavior, Sleep Disturbance, and Family Relationships and with the addition of Psychological Stress (lower scores indicating improvement). Caregivers also completed the PROMIS Global Health scale as a measure of their own HRQOL. Patients and caregivers completed HRQOL measures at admission, 6 and 12 months after HCT. We conducted paired samples t-tests to examine changes in HRQOL at different time points. Statistical significance was established at p<0.05. A 5-point difference between scores was deemed a minimal clinically important difference according to PROMIS guidelines. Results: Twenty individuals with SCD were treated and engrafted after HCT, of which 16 patients (mean age=14.1±4.6 years; 69% male, 63% HAPLO) and 18 caregivers completed HRQOL measures at two or more timepoints. There were 3 deaths on study; two patients did not have data for more than one timepoint and therefore were excluded from analysis. Patients reported improvement in Pain Interference from admission (M=56.1±10.7) to 6 months (M=51.3±10.2; t(15)=2.55, p=0.022). There was a nonsignificant but clinically meaningful improvement in Anxiety from admission (M=49.5±8.6) to 6 months (M=44.5±9.6; t(14)=1.99, p=0.067), which was significant by caregiver report from admission (M=54.8±8.3) to 6 months (M=45.3±8.9; t(13)=4.36, p=0.001). There were no patient or caregiver-reported significant changes in HRQOL from 6 to 12 months post-HCT. Patients did not report changes in HRQOL between admission to 12 months, however caregivers reported improvement in Physical Function (M=41.3±7.5 v. M=49.5 ±7.8; t(10)=-3.55, p=0.005), Anxiety (M =57.3±6.5 v. M=42.1±6.8; t(9)=6.74, p<0.001), Depression (M=51.6±8.9 v. M=41.3±7.9; t(10)=4.36, p=0.001), Fatigue (M=56.4±10.8 v. M=44.5±9.5; t(10)=2.98, p=0.014), Pain Interference (M=60.3±9.4 v. M=48.8±10.1; t(10)=3.29, p=0.008), and Psychological Stress (M=57.1±11.1 v. M=43.9±9.9; t(10)=2.94, p=0.015). Caregivers reported worsened Peer Relationships for their child comparing admission (M=47.8±11.3) to 6 months (M=39.2±10.2; t(14)=2.66, p=0.019). There were no significant differences in caregiver report of their own HRQOL for the timepoints. Conclusion: Patients reported improvement in Pain Interference from admission to 6 months post-HCT but overall HRQOL measures did not change from admission to 12 months post-HCT. Conversely, caregivers reported that their child's HRQOL improved from admission to 12 months post-HCT in 6/8 domains. These differing perspectives highlight the variability in HRQOL outcomes post-HCT between patients and caregivers and underscore the importance of considering both perspectives. Future research is needed with larger sample sizes and longer follow-up to better understand the impact of HCT on HRQOL and the incongruity between patient and caregiver report.

Background/Objectives: Pediatric oncology patients and families are at risk for increased distress at diagnosis. The New Oncology Program in Psychology (NOPP) aligns psychological care with the established standards of care at diagnosis. This project aimed to evaluate NOPP and understand the differences between caregivers’ perceptions of feeling informed and prepared to navigate psychosocial concerns for those who did and did not receive psychological services at diagnosis. Methods: A survey was administered via a virtual platform. Frequency analyses summarize caregiver experiences and concerns. Mann–Whitney U tests assess the differences in caregiver knowledge and preparedness between caregivers who did and did not receive psychological services. Results: Caregivers reported difficult emotions at diagnosis and expressed concern for the impact of diagnosis and treatment across broad domains of patient functioning. Caregivers of patients who received psychology consultation felt more informed about difficult emotions and how these may change over time. They felt more prepared and equipped with strategies to manage difficult emotions. Caregivers of patients who completed a cognitive assessment also felt more informed and prepared regarding the potential effects of the diagnosis and treatment on patient cognitive/academic functioning. Conclusions: Psychological services were associated with caregivers’ positive perceptions surrounding the management of difficult emotions and with their knowledge regarding the cognitive/academic impact. The results inform the ongoing modification of NOPP.

OBJECTIVEThe aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment.METHODSParticipants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship.RESULTSLatent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning.CONCLUSIONThe majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.

BackgroundRetinoblastoma is the most common intraocular childhood cancer and is typically diagnosed in young children. With increasing number of survivors and improved medical outcomes, long-term psychosocial impacts need to be explored. Thus, the current study sought to assess functioning in school-aged survivors of retinoblastoma. ProcedureSixty-nine survivors of retinoblastoma underwent a one-time evaluation of psychosocial functioning. Survivors (M-age = 10.89 years, SD = 1.07 years; 49.3% male; 56.5% unilateral disease) and parents completed measures of quality of life (QoL; PedsQL) and emotional, behavioral, and social functioning (PROMIS [patient-reported outcome measurement information system] Pediatric Profile, BASC-2 parent report). Demographic and medical variables were also obtained. ResultsOn the whole, both survivors and caregivers indicated QoL and behavioral and emotional health within the typical range of functioning. Survivors reported better physical QoL compared to both parent report and a national healthy comparison sample, whereas caregivers reported that survivors experienced lower social, school, and physical QoL than a healthy comparison. Regarding behavioral and emotional health, survivors indicated more anxiety than a nationally representative sample. Parents of female survivors endorsed lower adaptive scores than parents of male survivors. ConclusionsResults indicated that survivors of retinoblastoma reported QoL and behavioral and emotional health within normal limits, although parents appear to perceive greater impairment across several assessed domains. Understanding both survivor and parent reports remains important for this population. Future research should explore psychosocial functioning of these survivors as they transition to adolescence and early adulthood, given the increased independence and behavioral and emotional concerns during these developmental periods.

ObjectiveThe Social Problem-Solving Inventory-Revised (SPSI-R) is a widely used instrument to assess problem-solving ability. This study examined the factor structure of the 52-, 25-, and 10-item versions of the SPSI-R and assessed factorial invariance across English- and Spanish-speaking participants. In addition, the internal consistency, test-retest reliability and sensitivity to detect change in problem-solving skills over time were assessed across the three different versions of the SPSI-R.MethodsData from three randomized controlled trials, in which caregivers of children with cancer (N = 1,069) were assigned to either a problem-solving skills intervention (N = 728) or a control condition (N = 341), were combined. The SPSI-R was administered at baseline (T1) and immediately post intervention (T2). Reliability and multigroup analyses were performed with confirmatory factor analysis (CFA). Sensitivity to change analyses were performed using repeated measures ANOVA.ResultsConfirmatory factor analysis at T1 showed good fit statistics and internal consistency for the 52- and the 25-item versions, but not for the 10-item version. Factorial invariance was demonstrated across time (T1-T2) and language (Spanish-English) for both the 52- and 25-item versions. Adequate sensitivity to change over time was shown.ConclusionThe 52- and 25-item versions of the SPSI-R appear reliable and valid for assessment of problem-solving skills in English- and Spanish-speaking caregivers of children with newly diagnosed cancer. The 25-item SPSI-R can be used as a short version measuring problem-solving ability; the 10-item version cannot be considered a reliable measure for this population.

OBJECTIVE/BACKGROUND:Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits. PATIENTS/METHODS:Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data. RESULTS:Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent. CONCLUSIONS:Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.

The Social and Emotional Assets and Resilience Scale (SEARS) is a promising instrument for prediction of resilience in youth; however, there is limited data to support its use. The purpose of the current study was to examine the factor structure, measurement invariance, internal consistency, and validity of the SEARS-Adolescent Report in youth 8 to 20 years of age. Two hundred and twenty-five childhood cancer survivors (Mage = 15.9, SD = 4.2; 51.4% male; 74.5% White) and 122 student controls without history of significant health problems (Mage = 14.2, SD = 3.5; 54.1% female; 79.5% White) 8 to 20 years of age completed the SEARS-A. The SEARS-A was found to have an adequate factor structure and model fit (χ2 = 1215.5, p < .001; root mean square error of approximation = .057; comparative fit index = .95; standardized root mean square residual = .06) and demonstrated invariance across domains of age, health status, gender, race, and socioeconomic status (Δ comparative fit index < -0.01). It also demonstrated excellent internal reliability, criterion validity, and current validity when compared with another well-established measure of psychological adjustment. As such, the SEARS-A has potential to be a useful, valid, and psychometrically sound tool for predicting social-emotional adjustment outcomes among at-risk youth 8 to 20 years of age.

Parents are increasingly used as donors for their child's haploidentical hematopoietic cell transplant, creating a dual role for parents that may increase the stress of caring for their ill child. Empiric research on the psychological adjustment of parental donors is lacking. We conducted a retrospective survey of parents (n = 136) whose child underwent transplant with a parental donor or a matched-unrelated donor, including both donor and nondonors, and both parents of survivors and bereaved. All parents completed standardized measures of quality of life, depression, anxiety, post-traumatic stress, and life satisfaction. Bereaved parents also completed measures of their grief response, while parents of survivors completed measures of the parent–child relationship. The overall sample reported psychological functioning near normative levels, but bereaved parents demonstrated significantly poorer outcomes across all measures. The effect of donor status differed by transplant outcome: for parents of survivors, donors reported better mental health than nondonors, but amongst bereaved parents, donors fared more poorly than nondonors. Bereaved donors reported greater difficulties with grief than nondonors. Results suggest that serving as donor can be a double-edged sword, acting as a protective factor when there is a successful outcome but a significant risk factor when the child does not survive.

BACKGROUND:Young adults with cancer are a vulnerable group with unique emotional, social, and practical needs. There is a lack of evidence-based interventions to address their needs and to foster skills that could increase their capacity to cope. Bright IDEAS is a problem-solving skills training intervention that has demonstrated efficacy in improving people's problem-solving ability and reducing distress among caregivers of children with cancer. This study evaluated the feasibility and acceptability of Bright IDEAS adapted for young adults (Bright IDEAS-YA).METHODS:Forty young adults recently diagnosed with cancer were enrolled in a single arm feasibility study.RESULTS:Feasibility was demonstrated by the adequate enrollment (67.8%), retention (80.0%), and participants' adherence to the intervention (average of 5.2 out of 6 sessions completed). Participants reported satisfaction with the intervention. Qualitative feedback identified the systematic approach to problem-solving and interaction with the trainer as strengths of the intervention. Participants demonstrated improvements in problem-solving skills and symptoms of depression and anxiety.CONCLUSIONS:In conclusion, the results support the feasibility of the intervention and an adequately powered randomized controlled trial is needed to determine the efficacy of the intervention on psychosocial outcomes.

Objective: Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. Method: Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. Conclusions: Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions.

Objective Children with acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits, and examining individual variability is essential to understand these risks. This study evaluated latent longitudinal trajectories and risk factors of neurocognitive outcomes in childhood ALL. Methods There were 233 participants with ALL who were enrolled on a phase 3, risk-stratified chemotherapy-only clinical trial (NCT00137111) and who completed protocol-directed neurocognitive assessments [47.6% female, mean (SD)= 6.6 (3.7) years]. Measures of sustained attention, learning/memory, and parent ratings of attention were completed during and after treatment. Longitudinal latent class analyses were used to classify participants into distinct trajectories. Logistic regression was used to identify predictors of class membership. Results Within the overall group, attention performance was below age expectations across time (Conners Continuous Performance Test detectability/variability, p < 0.01); memory performance and parent ratings were below expectations at later phases (California Verbal Learning Test learning slope, p < 0.05; Conners Parent Rating Scale, Revised attention/learning, p < 0.05). Most participants (8089%) had stable neurocognitive profiles; smaller groups showed declining (3-6%) or improving (3-11%) trajectories. Older age (p= 0.020), female sex (p = 0.018), and experiencing sepsis (p= 0.047) were associated with greater attention problems over time. Lower baseline IQ was associated with improved memory (p= 0.035) and fewer ratings of attention problems (p= 0.013) over time. Conclusions Most patients with ALL have stable neurocognitive profiles. Smaller groups have significant impairments shortly after diagnosis or have worsening performance over time. A tiered assessment approach, which includes consideration of individual and clinical risk factors, may be useful for monitoring neurocognitive functioning during treatment and survivorship.

Background: The use of parental donors in pediatric haploidentical hematopoietic cell transplantation is increasing, but research on the psychosocial impact of parental donation is currently limited. We conducted a retrospective, qualitative study to explore parental perceptions of the donation process and the impact of being a donor (or non-donor) on parents’ adjustment and coping with their child’s transplant experience. Methods: Parents/caregivers of children who underwent transplantation with a parental donor or a matched unrelated donor (N = 136) participated in interviews and completed an open-ended questionnaire. Both bereaved parents and parents of survivors were surveyed. Results: Six themes were identified in the data: level of understanding and satisfaction; perception of choice; preparation for donation; perceptions of donation and infusion; benefit-finding; and psychological impact of transplantation. Most parents were satisfied with the information they received and reported a good understanding of transplantation and donation procedures. Parents were divided on perspectives of choice, but their responses reflect that the necessity of saving their child’s life does not allow for choice. They described considerable effort to prepare for transplantation, physically, emotionally, and logistically. Parents acknowledged the psychological impact while identifying positive outcomes that resulted from their child’s transplant journey. Conclusions: Results highlight the unique experiences of parental donors and non-donors from the anticipation phase to the completion of their child’s transplant. Additionally, findings inform supportive care guidance by highlighting the need to assess parental donors’ emotional functioning, provide support post-donation, and conduct bereavement follow-up.

OBJECTIVE:The primary aims of this research were to examine substance use among adolescent and young adult survivors of pediatric cancer (AYA survivors) and AYA without a history of chronic or life threatening illness (AYA comparisons) and to explore links between demographic, medical, caregiver-AYA, and family system factors with AYA substance use patterns.METHODS:Participants included 289 AYA (survivors, n = 171; comparisons = 118; 51% female; Mage = 17.15, SDage = 2.86) and their caregivers (Mage = 46.54, SDage = 6.81; 88% mothers). AYA and caregivers completed the family environment scale, and caregivers completed the parenting relationship questionnaire at the initial assessment. Two years later, AYA completed an assessment of substance use. Chi-square and frequency analyses were used to compare differences in substance use among AYA survivors and comparisons. Multivariate analysis of variance was used to examine links between AYA substance use patterns with family and caregiver-AYA system level factors.RESULTS:Patterns of substance use did not differ between AYA survivors and comparisons. AYA survivors were more likely to report polysubstance use if caregivers endorsed problematic caregiver-AYA relationship patterns. Family functioning and caregiver relationship patterns did not predict AYA comparison substance use.CONCLUSION:AYA survivors were just as likely as AYA comparisons to engage in substance use, increasing their vulnerability to problematic health outcomes. Findings indicate that the role caregiver-AYA relationship patterns may have on youth at risk for substance use and potential mechanisms for future intervention.

Objective: To identify and predict resilient functioning over time among youths with pediatric cancer experience (YPCE). Design: YPCE aged 8-17 years (N = 231) were followed prospectively for 3 years. Their psychosocial adjustment was assessed using self-report and parent-report at 1 year (T2) and 3 years (T3) post-baseline. Methods: Latent profile analysis identified subgroups of YPCE with different patterns of adjustment over time. Self-reported factors from baseline and T2 were examined as predictors of subgroup membership. Findings: Three subgroups of youths were found. Two exhibited average (52.5% of the sample) to better-than-average (41.3%) functioning. One subgroup (6.2%) exhibited subclinical but at-risk range of adjustment. Low optimism and low connectedness to parents and school predicted membership in this group. Conclusions: Most YPCE exhibit resilient functioning across time. However, approximately 6% report persistent maladjustment. Implications: Most YPCE are well-adjusted, but those with low optimism and poor connection to parents or school may require monitoring for psychosocial difficulties.

OBJECTIVEBright IDEAS (BI) is a problem-solving skills training (PSST) program that has been demonstrated in earlier randomized controlled trials (RCTs) to be an effective and specific intervention for improving problem-solving skills and reducing negative affect in caregivers of children with cancer. The objectives of this study were to (a) offer an approach to defining meaningful treatment response and to determine the rates of responsivity to PSST; and (b) identify characteristics of PSST responders and nonresponders.METHODSData from 154 mothers receiving the BI intervention were analyzed. Drawing on the literature on minimal clinically important differences, two criteria for determining responsivity were calculated for the primary outcome of problem-solving skills: (a) The reliable change index (RCI) based on group data, and; (b) The effect size (ES) of each participant's pre/postintervention change score as a function of the group's baseline SD.RESULTSThirty-three percent of the sample met both responsivity criteria immediately posttreatment (39% at follow-up) and 38% (39% at follow-up) met neither. An additional 29% demonstrated a small or greater ES (≥ 0.2) but did not meet the RCI criteria, suggesting possible benefit. The single consistent predictor of responsivity was participants' pretreatment problem-solving skills, with lower skills at baseline predicting greater improvement (p < .001).CONCLUSIONSThese findings highlight the need to go beyond group data in interpreting RCTs and to incorporate measures of meaningful treatment response. Our ability to predict and screen for meaningful treatment response is critical to more precise targeting, enhanced outcomes, and better resource allocation.