Clinical Sample Of Children Research Articles

Temperament in middle childhood questionnaire: New data on factor structure and applicability in a child clinical sample.

The Temperament in Middle Childhood Questionnaire (TMCQ) is one of a family of instruments representing one of the major conceptual models of child temperament. The present study reports new psychometric information on the TMCQ using a larger sample than in prior factor-analytic studies of this instrument. Data from parent ratings of 1,418 children were utilized. The sample of community volunteers included 697 typically developing youth and 721 defined by research diagnostic procedures as having attention-deficit/hyperactivity disorder. Results failed to support the original proposed structure of the TMCQ, but found support for a structure with 12 subscales that confirmed a substantial portion of the lower order factor structure. However, the intended three-factor higher order structure was not able to be fully recovered. Two-group invariance was supported in the final model, supporting use in studies of typical and atypical development. In conclusion, with some modifications the TMCQ remains a useful research measure at the lower order factor level. The validity of the higher order structure is less clear, likely due to measure-specific limitations, and suggests a need for some refinement to the measure. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Abstract 15156: Statistical Modeling of Cardiac-Derived Progenitor Cell Extracellular Vesicles to Predict Clinical Trial Outcomes

Introduction: Cardiac-derived c-kit+ progenitor cells (CPCs) are under investigation in the CHILD phase I clinical trial (NCT03406884) for the treatment of hypoplastic left heart syndrome (HLHS). Therapeutic efficacy of CPCs can be attributed to the release of extracellular vesicles (EVs), carrying beneficial RNA cargo. Despite some successes with pediatric cardiac cell therapy, large variation in cell populations and patient outcomes remains a problem. To investigate these discrepancies and understand sources of cell therapy variability we took a machine learning approach: combining bulk CPC-derived EV (CPC-EV) RNA sequencing and cardiac-relevant in vitro experiments to build a predictive model. Methods: We isolated CPCs from cardiac biopsies of congenital heart disease patients (n=30) and the lead-in HLHS patients in the CHILD trial (n=7). We cultured CPCs, collected EVs from the media, and sequenced EV miRNA and total RNA. We treated cardiac endothelial cells and fibroblasts with CPC-EVs and measured inflammatory or fibrotic gene expression with qRT-PCR. We treated mesenchymal stromal cells with CPC-EVs and assessed migration in a Boyden chamber system. We treated cardiac endothelial cells seeded on Matrigel with CPC-EVs and measured tube formation. Finally, we put together the CPC-EV sequencing and experimental data in partial least squares and regularized regression models. Results: With our models we determined that the most important CPC-EV RNA signals involved in pro-reparative outcomes had significant fit to cardiac development and signaling pathways. Furthermore, using a model trained on previously collected CPC-EVs, we were able to predict in vitro outcomes for the CHILD clinical samples. Finally, we formed rank-based predictions for the CHILD lead-in patients, based on the in vitro assays. Conclusions: The CHILD phase I trial is set to conclude next year. We will validate our predictions with the release of these clinical data. With this work, we (1) investigated the EV RNA signals involved in pediatric cardiac repair and (2) will use our in vitro results to predict CHILD clinical trial outcomes. Our results highlight the importance of quantitative studies in determining the underlying variance in pediatric cardiac cell therapy.

Cognitive-behavioral intervention for anxiety associated with food allergy in a clinical sample of children: Feasibility, acceptability, and proof-of-concept in children

BackgroundMultiple reviews have identified a lack of evidence-based treatments for excessive anxiety in the context of food allergy (FAA) as an unmet need. ObjectiveTo evaluate the feasibility, acceptability, and proof of concept of Food Allergy Bravery (FAB), a brief, novel, manualized cognitive-behavioral–based intervention for anxiety in a clinical sample of children with FAA. MethodsA total of 3 cohorts of children (aged 8 to 12 years) with clinically impairing FAA and their parents were offered a course of FAB delivered in a group format. Ratings of anxiety severity and quality of life were collected at pretreatment, posttreatment, and 2- to 4-month follow-up. ResultsAll families offered treatment completed the full course of FAB, attended at least 5 of 6 active treatment sessions, and rated the intervention as highly satisfactory. All children were rated as very much improved or much improved on the Clinician Global Impression scale at posttreatment. Anxiety severity scores on the Scale of Food Allergy Anxiety and the Scale of Child Anxiety–Related Emotional Disorders significantly declined per both child and parent reports. Scores on the Food Allergy Quality of Life Questionnaire–Parent Form were significantly improved. Gains were maintained at follow-up. ConclusionThis is the first study of an outpatient manualized psychosocial treatment for FAA in a clinically ascertained sample of children. Findings provide initial evidence of feasibility, acceptability, and proof of concept for the FAB intervention protocol. Randomized controlled trials are needed.

Validation of a tablet-based assessment of auditory sensitivity for researchers.

Quantifying hearing acuity is increasingly important across a wide range of research areas in the behavioral and neurosciences. Scientists have relied on either self-reported hearing status or the availability of diagnostic hearing assessment in past studies. There remains a need for a valid and reliable assessment of auditory sensitivity that can provide estimates of the magnitude of hearing loss, if present, without requirements for professional audiologists, facilities, and equipment that are needed to conduct a diagnostic hearing assessment. The goal of this experiment was to validate the NIH Toolbox® Hearing Threshold Test (HTT), a tablet-based hearing assessment available via iPad application that uses consumer-grade headphones, on a clinical sample of children and adults with varying degrees of hearing acuity. Electroacoustic analysis of the hearing assessment application and headphones demonstrated acoustic outputs within established conformity standards for hearing assessment. Twenty-seven children and 63 adults participated in a standard diagnostic hearing assessment and the experimental tablet-based assessment. The results showed that thresholds from the tablet-based assessment were highly correlated with thresholds from the clinical hearing assessment (r = .83-.93) for children and adults for all frequencies and across a range of levels of hearing acuity. The HTT also met clinical test-retest reliability standards (Cronbach's α > .86). The tablet-based hearing assessment provides acceptable estimates of hearing levels for children and adults when diagnostic audiometric assessment capabilities are not available.

Examining the Biopsychosocial Factors Related to Lifetime History of Concussion in Children and Youth.

This study investigated the prevalence of lifetime concussions, related psychosocial problems, and post-concussion recovery rates in a clinical sample of children and youth. Participants were 24,186 children and youth (M = 11.9years, SD = 3.5) who completed an interRAI Child and Youth Mental Health Assessment at mental health agencies across Ontario, Canada. In addition to the expected physiological correlates, results found concussions to be more prevalent in children and youth with attention deficit hyperactivity disorders, anxiety disorders, disruptive behaviour disorders, mood disorders, and those involved in self-harm, harm to others, destructive aggression, and internalizing and externalizing symptoms. The results of this study add to our understanding of children and youth's experiences with concussions. Clinical implications and recommendations are discussed to maximize the effectiveness of evidence-based interventions related to concussion recovery.

Mental health of children and adolescents with pre-existing psychiatric and developmental disorders during the first pandemic-related lockdown: A cross-sectional study in Greece

Since the onset of COVID-19 pandemic, concerns have been raised about the effects of the pandemic on youth with pre-existing mental health disorders. The present study aimed to explore change in emotional and behavioral symptoms (mood states) and daily behaviors during the lockdown in a clinical sample of children and adolescents in Greece. A cross-sectional survey, using the CoRonavIrus Health Impact Survey (CRISIS) Questionnaire, was completed by 738 parents of children and adolescents aged 2–18 years attending 12 outpatient child and adolescent mental health services (CAMHS) across four geographical regions in Greece. Participants reported at a single time-point on their children's mood states and daily behaviors 3 months prior to the pandemic and during the past two weeks, as well as on life changes during the spring 2020 lockdown. Using paired samples t-tests no change was found in mean mood states scores pre- and post-pandemic onset in all subgroups investigated. Using McNemar's test, we found that among individual mood states, some symptoms increased, and others decreased or remained stable. Additionally, participants did rate several of their daily behaviours as having overall worsened, e.g., reduced sleep or time spent outdoors during the lockdown, as compared to 3 months prior the pandemic. Longitudinal studies are needed to ascertain which factors buffer against deterioration of mental health among children with pre-pandemic psychiatric or developmental disorders, in order to inform public mental health and educational policy.

Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism

BackgroundApplied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes.PurposeThe purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder.MethodsThis observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite.ResultsThere was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period.ConclusionsIn a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.

Psychopathic traits and emotion processing in a clinical sample of children with disruptive behavior disorder

Psychopathic traits and emotion processing in a clinical sample of children with disruptive behavior disorder

Description of Clinician-Diagnosed Regression at Time of Autism Spectrum Disorder Diagnosis in Toddlers.

Previous studies have reported varying rates of regression in children with autism spectrum disorder (ASD). We sought to (1) determine the rate of clinician-diagnosed regression for young children with ASD and (2) compare developmental functioning and ASD symptoms of children with versus without regression. We conducted a retrospective chart review of toddlers (age 18-36 months) with Diagnostic and Statistical Manual-5 ASD. We abstracted cognitive, language, adaptive, and motor functioning standard scores and ASD core symptoms. Regression was defined as "clinician-diagnosed regression accompanied by recommendation for a medical workup." We used propensity scores to match each participant with regression (n = 20) one-to-one with a participant without regression (n = 20). We compared the groups on developmental scores using independent sample t tests and on core ASD symptoms using Pearson's χ 2 test. Of the 500 children with ASD, n = 20 (4%) had regression (defined above). Children with regression had lower Bayley cognitive and language scores and lower Vineland adaptive scores compared with those without regression (cognitive: 78.0 vs 85.5, p < 0.05; language: 56.9 vs 68.2, p < 0.01; adaptive: 70.0 vs 80.3; p < 0.01). There was no difference in motor scores across groups. There were no significant differences in the frequency of exhibiting core ASD symptoms for those with versus without regression. In this clinical sample of children with ASD, regression was diagnosed in a small percentage (4%). Those with regression had lower cognitive, language, and adaptive skills compared with those without regression. Rates of clinician-diagnosed regression referred for medical workup are significantly lower than prior estimates based on parent report.

Outcomes and Mechanisms of Change of the Strengthening Families Program in a Clinical Sample of Children and Their Families in Austria.

Family context and parenting behavior have the greatest influence on children’s mental health and well-being, and interventions that take the whole family system into account are promising. This study aims to evaluate the outcomes, i.e., family strength, parenting behavior, and child behavior, of the Strengthening Families Program (SFP), developed by Kumpfer which was implemented in an outpatient clinic of a community-based non-governmental organization in Austria between 2012 and 2018. Furthermore, the program’s mechanism of change as formulated by the program authors (i.e., to what extent parenting behavior mediates the relationship between family strength and child behavior) was tested in this clinical sample. Instruments measuring family strength, parenting behavior, and child behavior were administered before, immediately after, and 6 months after participation in the SFP. To test the mechanisms of change, a half-longitudinal model was applied with two measurement points (before and after). A total of 62 families (50 boys, 24 girls, and 69 parents) participated in the culturally adapted SFP. Regarding the outcomes of the program, all variables yielded significant improvement in all variables. With respect to the mechanism of change, no significant association between the variables could be found. Implications for the implementation of the SFP in a clinical population and how further adaptation of the program could enhance the adherence of this target group are discussed.

Differences in Demographic, Risk, and Protective Factors in a Clinical Sample of Children who Experienced Sexual Abuse Only vs. Poly-victimization.

Children exposed to child sexual abuse (CSA) vary considerably with regards to their presenting concerns and treatment needs. One factor creating heterogeneity amongst children experiencing CSA is their history of experiencing other victimizations (i.e., poly-victimized or not). However, little is known about risk factors for poly-victimization as well as differences in protective factors among these two groups. Additionally, there is currently limited understanding of whether poly-victimization is associated with greater trauma symptoms in children exposed to CSA and being seen for trauma treatment. Using a clinical sample of 117 children who were sexually abused (64 CSA only and 53 poly-victimized) ranging from age 3–18 years, the current study examined demographic characteristics, abuse characteristics, trauma symptoms, and protective factors using casefile review methodology. After accounting for other risk factors, parental abuse history and protective factors were significantly associated with child poly-victimization status. Children exposed to poly-victimization were more likely to have financial concerns = 4.16, p = 0.04, parents with abuse histories = 8.93, p = 0.003, and parents with histories of mental health or substance use difficulties = 4.02, p = 0.045. Although cumulative trauma symptoms scores were higher for children who were poly-victimized compared to CSA only, t(115) = −2.24, p = 0.03, multiple regression analyses showed that poly-victimization status was not significantly associated with child trauma symptoms after accounting for other demographic and abuse characteristics. Assessing and understanding the extent to which children exposed to CSA have experienced other forms of maltreatment is critical for identifying children who may be most at risk of poor outcomes.

Supplemental Material for Temperament in Middle Childhood Questionnaire: New Data on Factor Structure and Applicability in a Child Clinical Sample

Supplemental Material for Temperament in Middle Childhood Questionnaire: New Data on Factor Structure and Applicability in a Child Clinical Sample

Suicidality and self-injury with selective serotonin reuptake inhibitors in youth: Occurrence, predictors and timing.

ObjectiveMeta‐analyses have established a heightened risk of suicidality for youth treated with selective serotonin reuptake inhibitors (SSRIs). The present study investigates the risk and possible predictors of suicidality and non‐suicidal self‐injury (NSSI) associated with SSRI treatment in a clinical sample of children and adolescents.MethodsAn observational, longitudinal, retrospective study using a within‐subject study design including in‐ and outpatients aged 0–17 years treated with SSRIs. Data were obtained from digital medical records and prescription software.Results N = 365 patients were included (64.1% female), mean (SD) age 14.5 (2.04) years, with primary depression, anxiety or obsessive‐compulsive disorder. No suicides occurred. When comparing the 6‐week period immediately prior to versus following SSRI initiation, the patient proportion with broadly defined suicidality decreased (38.5% vs. 24.2%, p < 0.001) while the proportion with suicide attempts was stable (2.8% vs. 2.8%, p = 1.000). The proportion with NSSI decreased statistically non‐significantly (12.4% vs. 8.4%, p = 0.067). Results from individually standardized observation periods were similar; however, the proportion with suicide attempts decreased statistically non‐significantly and the proportion with NSSI decreased significantly. Suicidality during SSRI treatment was associated with previous suicidality (OR[CI] = 6.0 [2.4–14.8], p < 0.001), depression as indication for SSRI treatment (OR[CI] = 2.1 [1.2–3.7], p = 0.01), female sex (OR[CI] = 2.1 [1.1–4.1], p = 0.02) and previous NSSI (OR[CI] = 2.0 [1.2–3.5], p = 0.01).ConclusionSuicidality was common in youth treated with SSRIs. The patient proportion with overall suicidality decreased, and the proportion with attempted suicide was stable in the weeks following SSRI initiation. Previous suicidality, depression, female sex and previous NSSI are important predictors for suicidality during SSRI treatment in youth.

Prevalence of Various Traumatic Events Including Sexual Trauma in a Clinical Sample of Patients With an Eating Disorder.

Objective: Eating disorder (ED) and trauma have often been associated, and there is evidence that early experiences of traumatic events are associated with subsequent ED. Research results point toward an increased prevalence of sexual trauma in individuals with ED, and it has been suggested that sexual trauma precedes and contributes to the development of ED. The aim of this study was to assess the prevalence of sexual trauma as well as other types of traumatic life events in a clinical sample of children, adolescents, and adults with ED.Method: Patients (N = 329), median age 16.9 [Interquartile Range (IQR):4.5], diagnosed with various EDs in a specialized ED unit were included.Results: The majority (67%) of patients with ED reported at least one traumatic life event at time of assessment such as bullying (32%), loss (24%), or accidents (11%). Nineteen per cent of the patients reported having been the victim of a sexual trauma or another sexual traumatic event distributed as follows in terms of severity: 13% had been the victim of a negative experience associated with sex; 57% reported having experienced sexual assault other than rape; and 30% had been the victim of severe forms of sexual assault. The median time between the sexual trauma and the ED diagnosis was 3.4 years (IQR: 6.6). The median time between the sexual trauma and the onset of ED symptoms was 0 years (IQR: 5). The study results imply that the sexual trauma could be experienced either prior to or after onset of ED symptoms.Conclusions: Sixty-seven per cent of the patients with an ED reported traumatic life events at time of assessment, whereby 19% reporting negative sexual experiences or sexual abuse. However, sexual trauma does not necessarily play a causal role in the development of EDs.

Parenting Practices, Bedtime Routines, and Consistency: Associations with Pediatric Sleep Problems.

Investigate the direct and moderating effects of daytime parenting practices on the relationship between bedtime routines and pediatric sleep problems. A community sample of 407 parents with children 2-10 years old completed measures of parenting practices (i.e., laxness and over-reactivity) and bedtime routines (i.e., consistency and reactivity to changes in routines). Sleep problems (i.e., severity and signaled night waking) were assessed by a parent-report questionnaire and sleep diaries. Higher parenting laxness (β = .13) and less bedtime routine consistency (β = -.34) significantly predicted sleep problem severity. Laxness moderated the relationship between bedtime reactivity and sleep problem severity: when bedtime reactivity was high, higher parental laxness was associated with more severe sleep problems. Daytime parenting practices are important to consider when children are reactive to changes in bedtime routines, as permissive or inconsistent daytime parenting practices were found to be associated with more severe sleep problems. Future research should examine the effects of parenting practices and bedtime routines on problematic signaled night waking in a clinical sample of children.

The analysis of network structure among the depressive symptoms in a clinical sample of children and adolescents.

The symptoms of depressive disorder in children and adolescents vary widely and have complex interconnections with each other. This study aimed to identify the network structures among individual depressive symptoms in clinically referred children and adolescents. A total of 464 children and adolescents who visited the outpatient psychiatry clinic in South Korea were enrolled. The Children's Depression Inventory (CDI) was used to assess depressive symptoms. To construct the network structure and estimate the centrality indices among individual symptoms, the Gaussian graphical model was utilized with the tuning parameter to minimize the extended Bayesian information criterion. Among all symptoms, self-hatred had the highest strength centrality, followed by crying and self-deprecation. Among 191 valid edges constituting the CDI symptom network, sadness-crying, school work difficulty-school performance decrement, disobedience-fights, misbehavior-low self-esteem, self-deprecation-self-blame, school dislike-lack of friendship, self-hatred-negative body image, anhedonia-social withdrawal, self-hatred-suicidal ideation, crying-irritability, and sadness-loneliness showed significantly higher weights than the other edges. The present study identified the network structure among depressive symptoms in children and adolescents. Future studies including more symptoms of depression are warranted to provide insights into the underlying mechanisms of child and adolescent depression.

Diverse patterns of vulnerability to visual illusions in children with neurodevelopmental disorders.

Research on how children with neurodevelopmental disorders perceive, process, and interpret visual illusions (VIs) has been extensively focused on children with autism spectrum disorder providing controversial findings. In this study, we investigated the patterns of vulnerability to a wide set of VIs comprising 23 standard text book VIs and their variations in a clinical sample of children with neurodevelopmental disorders compared to typically developing children (TD). A total of 176 children, aged between 4.6 and 13.8years old, were distributed into four groups: high-functioning autism (HFA; N = 23), attention-deficit/hyperactivity disorder (ADHD; N = 42), specific learning disorder (SLD; N = 70), and TD (N = 41). Regression models, adjusted for sex, age, and non-verbal IQ, showed that HFA was associated with greater responses accuracy than TD children to the full battery of VIs, to the cognitive illusions, to the distortions, and to both geometrical illusions of size/shape (cognitive distortions) and lightness contrast effects (physical distortions). The susceptibility of ADHD children was found attenuated for illusory contours and greater for paradoxical illusions in comparison with TD children. No significant differences were shown between the SLD group and the TD children. Our findings, which were adjusted for the same duration of visual working memory across groups, showed that there is a potential specific tendency of HFA children to failure of processing visual information in context. Contrarily, children with ADHD showed in general normal global processing such as children diagnosed with SLD.

Autism Diagnostic Observation Schedule (ADOS-2) elevations in a clinical sample of children and adolescents who do not have autism: Phenotypic profiles of false positives

Objective While the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) shows high sensitivity for detecting autism spectrum disorder (ASD) when present (i.e. true positives), scores on the ADOS-2 may be falsely elevated for individuals with cognitive impairments or psychological concerns other than ASD (i.e. false positives). This study examined whether demographic, psychological, cognitive, and/or adaptive factors predict ADOS-2 false positives and which psychiatric diagnoses most often result in false positives. Method Sensitivity, specificity, false positive, and false negative rates were calculated among 214 5- to 16-year-old patients who completed an ADOS-2 (module 3) as part of an ASD diagnostic evaluation. Additional analyses were conducted with the 101 patients who received clinically elevated ADOS-2 scores (i.e. 56 true positives and 45 false positives). Results Results revealed a 34% false positive rate and a 1% false negative rate. False positives were slightly more likely to be male, have lower restricted and repetitive behavior (RRB) severity scores on the ADOS-2, and demonstrate elevated anxiety during the ADOS-2. Neither IQ, adaptive functioning, nor caregiver-reported emotional functioning was predictive of false positive status. Trauma-related psychiatric diagnoses were more common among false positives. Conclusions The ADOS-2 should not be used in isolation to assess for ASD, and, in psychiatrically-complex cases, RRB symptom severity may be particularly helpful in differentiating ASD from other psychiatric conditions. Additionally, heightened levels of anxiety, more so than overactivity or disruptive behavior, may lead to non-ASD specific elevations in ADOS-2 scores.

Gender Differences in Witnessing and the Prevalence of Intimate Partner Violence from the Perspective of Children in Finland.

Background—Intimate partner violence (IPV) has both direct and longer-term effects on children’s well-being. Much of the research thus far has relied on caregiver reports of IPV and clinical samples of children. By contrast, minimal research has examined violence between parents from the perspective of children using nationwide samples. Objective—This study explored the frequency of IPV witnessed by children and gender variations regarding the victims, perpetrators, and witnesses. Methods—The data were derived from a sample of 11,364 children from the Finnish Child Victim Survey 2013. The children were between 11 and 17 years old and were enrolled in the Finnish school system. The main methods of analysis included crosstabulation and the chi-square test. Results—The results indicate that children witnessed more IPV against their mother (4.9%) than their father (3.5%). Girls reported having witnessed more violence against both their mother (7.0%) and father (5.1%) than boys did (mothers 2.7%, fathers 1.8%). Girls’ reports of IPV against both parents were twice or more than twice as common as boys’ reports. Conclusions—The above differences might result from gendered expectations and boys’ and girls’ different relationships to violence, as well as differences in the recognition and interpretation of violent incidents. Therefore, practitioners should adopt a gender-sensitive approach as a precondition and practice for working with children in social and health care.

The Pittsburgh Sleep Quality Index: Reliability, Factor Structure, and Related Clinical Factors among Children, Adolescents, and Young Adults with Chronic Pain.

This study is aimed at assessing the psychometric properties and the factorial structure of the Pittsburgh Sleep Quality Index (PSQI) in a clinical sample of children, adolescents, and young adults with chronic pain. Data of 482 participants (aged 8-21 years) from two crosssectional studies and a chronic pain services outpatient clinic were analyzed. Exploratory and confirmatory factor analysis and reliability analysis of PSQI component scores were performed. Relationships between the PSQI global score and various clinical measures were investigated to assess external validity. The findings exhibit the reliability and validity of a single-factor model of the PSQI in a clinical sample of youth with chronic pain and support the relationship in this specific population between poor sleep quality and important clinical measures of well-being. These results support an informed decision regarding its use with this specific population and underscore the clinical relevance of assessing sleep quality.