Child Self-report Research Articles

Fluctuations in children’s self-regulation and parent-child interaction in everyday life: An ambulatory assessment study

Self-regulation has mostly been studied as an intrapersonal trait which fluctuates across time and impacts everyday behavior related to individual goal pursuit and achievement. Although it is plausible that self-regulation affects not only individuals but also their social network, there is less research on how self-regulation levels and fluctuations are linked to social processes in daily life, such as interactions between children and their parents. To this end, this study tracked children’s (aged 9 to 11 years; N = 70) self-regulation, and their daily interaction quality with parents, across 54 days, using child and parental self-reports. Participants reported higher interaction quality in dyads in which children showed higher self-regulation levels in comparison to others, as well as on days on which children showed higher self-regulation compared to their typical levels. The extent of this association varied between dyads, which needs to be addressed in future studies. As self-regulation and parent-child interaction quality fluctuate in parallel, this study suggests that researchers should aim to understand the underlying mechanisms in order to develop dynamic self-regulation interventions in family contexts and improve family well-being.

Salivary immune markers are not associated with self-reported childhood maltreatment or psychopathology in adults

BackgroundPsychological stress has repeatedly been found to be associated with pro-inflammatory markers in blood, and neuro-inflammation may play a role in the development of psychopathology after early life stress. Salivary immune testing is a novel method to non-invasively assess immune functioning. We examined a large range of salivary immune markers in relation to self-reported childhood maltreatment and psychopathology in an adult sample. MethodsParticipants (N = 118, 51% female, mean age = 46.6 yrs, range 22–64) were drawn from a cross-sectional three-generation study, and supplied 2 ml of saliva via passive drool. They reported on childhood maltreatment experiences and on psychopathological symptoms in the last 6 months. Hair cortisol was additionally assessed in a subsample (n = 68). Levels of IL1ß, IL6, IL8, IFNγ, TNFα, tIgE, sIgA, FLCƛ, and FLCƙ were assessed. ResultsLinear mixed model analyses showed that several salivary immune markers were associated with age (sIgA and IgE), BMI (sIgA, IL1ß, and IL6), sex (FLCs and IgE), and bad health (IL6, IL8, TNFα). No associations with (anti-inflammatory) medication use or oral health problems were found. Notably, no associations between the immune markers and self-reported childhood maltreatment, psychopathology, or hair cortisol were found. ConclusionsSalivary immune measures were found to be sensitive to individual differences in age, sex, health and BMI. However. in the current sample there was no indication of inflammation in relation to chronic psychological stress. Larger studies, including participants with higher stress levels, are needed to further examine associations between salivary immune markers and psychological stress.

Associations between caregiver stress and child verbal abuse and corporal punishment in Thailand’s impoverished Deep South region during the COVID-19 pandemic

The objectives of this study are: (1) To describe the levels of parental stress, self-reported child verbal abuse and corporal punishment among caregivers, and; (2) To assess the extent that having moderate or higher levels of parental stress is associated with self-reported child verbal abuse and corporal punishment. We randomly sampled 12 villages and sampled 40 households per village in Thailand’s impoverished Deep South region in June 2020. Study participants included 466 caregivers residing in sampled households. Trained enumerators used the standard ST-5 questionnaire to measure stress level and asked the participants to self-report the study outcomes. We analyzed data using descriptive statistics and multivariate logistic regression analyses. Approximately 19.1% of caregivers reported moderate, high, or severe level of stress. Caregivers with moderate and higher levels of stress were more likely than caregivers with low level of stress to report child verbal abuse (48% vs. 23%, respectively; Adj. OR = 3.11, 95% CI = 1.90, 5.11) and corporal punishment (28% vs. 8%, respectively; Adj. OR = 2.62, 95% CI = 1.36, 5.04). We found associations between caregiver’s stress level and self-reported verbal abuse and corporal punishment of children in the household. However, social desirability, lack of details in the answers, and potential confounding by mental illness co-morbidities were notable limitations of the study.

Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults.

Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect. To assess the association between five types of self-reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort. This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self-reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up. One-fifth reported maltreatment (n=362), most commonly emotional neglect (n=175), followed by emotional abuse (n=128), physical neglect (n=123), sexual (n=121) and physical abuse (n=116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and HDL levels. Results for other outcomes were more equivocal. Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity.

A scoping review of nausea, vomiting and retching measurement methods in children with cancer.

Evaluation of chemotherapy-induced nausea and vomiting (CINV) in the pediatric population is subject to diverse approaches. This scoping review summarizes the methods used in clinical studies that assessed nausea, vomiting or retching in children with cancer. We conducted a literature search of studies indexed in EMBASE and Ovid MEDLINE after 2000. Studies were included if they involved patients ≤18 years of age diagnosed with cancer, and had nausea, vomiting or retching as a primary study outcome. We excluded studies that reported only parent- or clinician-proxy measures without including the child's self-reported NVR, and those without specifying the NVR data collection process. The literature search identified twenty-four studies evaluating pediatric nausea, vomiting or retching. In the assessment of NVR, structured surveys were the most commonly used instrument for NVR assessment (75%) and the use of patient diaries (50%). Nine studies (38%) relied solely on self-reports from children as the outcome measure, while fifteen studies (62%) solicited input from parents/ caregivers and healthcare providers in addition to children's self-reports. Almost all the studies reported the frequency (n = 24) and/or severity (n = 23) of NVR symptoms and the use of antiemetic therapy (n = 19). Fewer studies evaluated distress caused by the symptoms (n = 2) and the effects of symptoms on activities of daily living (n = 4). Incorporating NVR measurement tools as part of standard of care for pediatric patients undergoing chemotherapy is strongly advocated. Based on the age group, we recommend the use of such tools comprising Likert scale, pictorial scales and structured scripts to assess various dimensions of a child's NVR experience.

Retrospective Self-Reported Childhood Experiences in Enriched Environments Uniquely Predict Prosocial Behavior and Personality Traits in Adulthood.

What features of people's childhood environments go on to shape their prosocial behavior during adulthood? Past studies linking childhood environment to adult prosocial behavior have focused primarily on adverse features, thereby neglecting the possible influence of exposure to enriched environments (e.g., access to material resources, experiences with rich cooperative relationships, and interactions with morally exemplary role models). Here, we expand the investigation of childhood environmental quality to include consideration of enriching childhood experiences and their relation to adult prosociality. In two cross-sectional studies, we found promising evidence that enriched childhood environments are associated with adult moral behavior. In study 1 (N = 1,084 MTurk workers), we adapted an existing measure of enriched childhood environmental quality for retrospective recall of childhood experiences and found that subjects' recollections of their enriched childhood experiences are distinct from their recollections of adverse childhood experiences. In Study 2 (N = 2,208 MTurk workers), we found that a formative composite of subjects' recollections of enriched childhood experiences is positively associated with a variety of morally relevant traits in adulthood, including agreeableness, honesty-humility, altruism, endorsement of the principle of care, empathic responding to the plights of needy others, and charitable donations in an experimental setting, and that these associations held after controlling for childhood environmental adversity, childhood socioeconomic status, sex, and age. We also found evidence suggesting that some, but not all, of the relationship between enrichment and adult prosociality can be explained by a shared genetic correlation. We include a new seven-item measure as an appendix.

Pediatric Patient-Reported Outcomes in Chronic Disease

Managing chronic disease is increasingly important in pediatric health care. In internal medicine, patient-reported, patient-important outcomes are a key part of assessment of programs. In pediatrics, there has been less focus on patient-reported outcomes. These outcomes are more complex in pediatrics because the utility of patient-reported outcomes may differ by age and, in most cases, parent-reported outcomes are also relevant. In some instances, parents serve as a surrogate for the pediatric patient. In other circumstances, parent-reported outcomes may differ from child-reported outcomes. In this volume of the Journal, Forrest et al report on self-reported child health outcomes across 10 chronic conditions. Across all these conditions, children reported more anxiety, fatigue, pain, and restriction of mobility than reported in the general pediatric population. Disease activity was associated with poorer self-reported outcomes. These results emphasize the need to incorporate patient-reported outcomes in pediatric chronic disease management. Programs will need to develop strategies to improve these patient-reported outcomes. Article page 207

No Sex Differences in Self-Reported Childhood Maltreatment in Major Depressive and Bipolar Disorders: A Retrospective Study.

Background: We investigated, for the first time, whether there are any sex differences in retrospective self-reported childhood maltreatment (CM) in Italian adult patients with major depressive disorder (MDD) or bipolar disorder (BD). Furthermore, the potential impacts of patients’ age on the CM self-report were investigated. Methods: This retrospective study used the data documented in the electronic medical records of patients who were hospitalized for a 4-week psychiatric rehabilitation program. CM was assessed using the 28-item Childhood Trauma Questionnaire (CTQ), which evaluates emotional, physical, and sexual abuse, as well as emotional and physical neglect. The linear and logistic regression models were used (α = 0.01). Results: Three hundred thirty-five patients with MDD (255 women and 80 men) and 168 with BD (97 women and 71 men) were included. In both samples, considerable CM rates were identified, but no statistically significant sex differences were detected in the variety of CTQ-based CM aspects. There was a significant association, with no sex differences, between increasing patients’ age and a decreasing burden of CM. Conclusion: Both women and men with MDD or BD experienced a similar and considerable CM burden. Our findings support routine CM assessment in psychiatric clinical practice.

Self-reported Adverse Childhood Experiences Among Custodial Grandmothers: Frequencies, Patterns, and Correlates.

Given the scarce past research on custodial grandparents' early life circumstances, we investigated frequencies, patterns, and predictors of 14 adverse childhood experiences (ACEs) reported by 355 custodial grandmothers (CGMs). Predominant ACEs were bullying (54.6%), verbal abuse (51.5%), physical abuse (45.4%), and living with a substance abuser (41.1%). Only 11% of CGMs reported 0 ACEs, whereas 52.4% reported >4. Latent class analyses yielded three classes of ACE exposure: minimal (54.1%), physical/emotional abuse (25.9%), and complex (20.0%). Age was the only demographic factor related to ACE class, with the complex class being younger than the other two. MANCOVAs with age as a covariate revealed that different ACE profiles have unique impacts on CGMs' physical and psychological well-being. We conclude that ACEs are highly prevalent among CGMs and a serious public health concern. Future research addressing ACEs among CGMs is critical in order to support these caregivers and promote resilience in custodial grandfamilies.

Quality of life, illness perceptions, and parental lived experiences in TANGO2-related metabolic encephalopathy and arrhythmias.

TANGO2 disorder is a rare genetic disease with multi-system effects that causes episodic crises. Quality of life and psychosocial effects of this rare disease have not previously been studied. To examine health-related quality of life (HRQoL), illness perceptions, and lived experience, we surveyed 16 children and 31 parents of children with TANGO2 disorder identified via a disease-specific social media group and research foundation email distribution list. We assessed HRQoL by parent proxy-report and child self-report using the Pediatric Quality of Life Inventory (PedsQL™). Parental perceptions of their child's condition were assessed using the revised illness perceptions questionnaire adapted for TANGO2 disorder (IPQ-R-TANGO2). To collect qualitative data on parents' lived experience, we used novel open-ended survey questions. Parent proxy-reported (n = 29) physical (78.4 (21)) and psychosocial health (73.4 (12.8)) were highest among toddlers with TANGO2 disorder. Parent proxy-reported physical health was lowest in young adults (34.4 (35.4)), and psychosocial health was lowest in teens (40.8 (10.8)). When compared to previously published PedsQL™ scores in healthy children, parent-proxy reported summary and scale scores for TANGO2 patients were significantly lower (all p < 0.001). Parents' IPQ-R-TANGO2 responses (n = 26) suggested that parents perceived significant negative consequences of the disease. Parents'open-ended survey responses (n = 21) highlighted that they derived support from the TANGO2 community. This study characterizes HRQoL in patients with TANGO2 disorder across a range of ages, identifies potential targets for HRQoL improvement, and provides valuable insight into the psychosocial effects of TANGO2 disorder on patients and their families.

Unintentional Tobacco Smoke Exposure in Children.

Secondhand smoke (SHS) exposure increases the prevalence and severity of sinopulmonary diseases in children. The primary source of SHS exposure in children is through adults who live in the same house; however, the level of exposure may vary based on the adult smoking habits at home. This prospective cross-sectional study in Alberta, Canada, investigated the relationship between self-reported caregiver smoking, location, outdoor temperature and children’s’ urine cotinine: creatinine ratio (CCR), a marker of nicotine metabolism. Participants aged 0–9 were recruited from the Child Health Clinics at the Misericordia Community Hospital in Edmonton, Alberta, from 8 January to 24 February 2016 and 30 June to 18 August 2016. Participant CCR levels were compared to caregiver-reported smoking location and environmental factors such as temperature and season. Of the 233 participants who reported smoking status, 21% reported smoking, in keeping with local smoking rates. More participants smoked indoors during the winter than the summer; however, some families limited indoor smoking to a garage. Of the 133 parent–child dyads who provided smoking information and a child urine sample, 18 had an elevated cotinine:creatinine ratio, suggestive of significant tobacco smoke exposure, 15 of whom were from homes that reported smoking. Age < 1 year and number of cigarettes smoked in the home weekly were risks for significant exposure while season, outdoor temperature and smoking location in the home did not reach significance. Smokers should be counseled to protect children, particularly infants, from exposure by limiting the number of cigarettes smoked and isolating smoking to outside the home. Segregated areas such as a garage may provide a useful harm mitigation strategy for indoor smokers, provided the garage does not share ventilation or is not in close proximity to high-traffic areas of the home.

Differences in health-related quality of life in children with chronic kidney disease as reported by children and parent proxies.

Correlation between reports of children and parent for health-related quality of life (HRQOL) is not well studied. This study aims to assess the degree of agreement between child self- and parent proxy-rated HRQOL and to identify factors associated with discordance at baseline and during follow-up in Taiwanese children with chronic kidney disease (CKD). This study includes pediatric patients aged 5-18years with confirmed CKD. Participants completed the generic version of the Pediatric Quality of Life Inventory (PedsQL) at baseline and every 6months during follow-up. Child-parent agreement on HRQOL reports was assessed using intraclass correlation coefficient (ICC). Multivariate regression models were used to determine factors associated with child-parent discordance. Of the 112 child-parent dyads included in the analysis, 97 dyads with 640 patient visits were assessed in 4.5years. Children reported higher total scores on the physical and psychosocial domains as compared to their parent proxies. ICC was low (< 0.5) for the psychosocial domain and moderate for the physical health domain at initial assessment and slightly increased for the physical health (0.62) and for school functioning (0.51) during follow-up. Development of mineral bone disorder/anemia (β, 11.75 [3.77-19.72]) and proteinuria (β, 8.48 [1.15-15.81]) in the follow-up were associated with increased discordance in school functioning, and fathers with chronic disease were associated with increased discordance in social functioning (β, 4.21 [0.68-7.74]). Parent proxy consistently estimated lower PedsQL score compared to self-reports of children. Child self-rated psychosocial health domains should be evaluated whenever possible to better elucidate treatment outcome over time. A higher resolution version of the Graphical abstract is available as Supplementary information.

Effectiveness of a home-environmental intervention package and an early child development intervention on child health and development in high-altitude rural communities in the Peruvian Andes: a cluster-randomised controlled trial

BackgroundUnsafe drinking water, poor sanitation and hygiene, exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low- and middle-income countries. We implemented an integrated home-environmental intervention package (IHIP), comprising a kitchen sink, hygiene education and a certified improved biomass cookstove, and an early child development (ECD) programme to improve children´s health and developmental outcomes in the rural high-altitude Andes of Peru.MethodsWe conducted a one-year cluster-randomised controlled trial among 317 children < 36 months divided into 4 arms (IHIP + ECD, IHIP, ECD, and Control) and 40 clusters (10 clusters per arm). ECD status (socio-emotional, fine and gross motor, communication, cognitive skills, and an overall performance) measured with the Peruvian Infant Development Scale and the occurrence of self-reported child diarrhoea from caretakers were primary outcomes. Secondary outcomes included the occurrence of acute respiratory infections and the presence of thermo-tolerant faecal bacteria in drinking water. The trial was powered to compare each intervention against its control arm but it did not allow pairwise comparisons among the four arms. Primary analysis followed the intention-to-treat principle. For the statistical analysis, we employed generalised estimating equation models with robust standard errors and an independent correlation structure.ResultsWe obtained ECD information from 101 children who received the ECD intervention (individually and combined with IHIP) and 102 controls. Children who received the ECD intervention performed better in all the domains compared to controls. We found differences in the overall performance (64 vs. 39%, odd ratio (OR): 2.8; 95% confidence interval (CI): 1.6–4.9) and the cognitive domain (62 vs 46%, OR: 1.9; 95% CI: 1.1–3.5). Data analysis of child morbidity included 154 children who received the IHIP intervention (individually and combined with ECD) and 156 controls. We recorded 110,666 child-days of information on diarrhoea morbidity and observed 1.3 mean episodes per child-year in the children who received the IHIP intervention and 1.1 episodes in the controls. This corresponded to an incidence risk ratio of 1.2 (95% CI: 0.8–1.7).ConclusionsChild stimulation improved developmental status in children, but there was no health benefit associated with the home-environmental intervention. Limited year-round access to running water at home and the possible contamination of drinking water after boiling were two potential factors linked to the lack of effect of the home-environmental intervention. Potential interactions between ECD and home-environmental interventions need to be further investigated.Trial registration: ISRCTN, ISRCTN-26548981. Registered 15 January 2018—Retrospectively registered, https://doi.org/10.1186/ISRCTN26548981.Graphical abstract

A longitudinal study of Estonian mothers’ self-reported language teaching practices and children’s language skills

This study explored associations between mothers’ language teaching practices and children’s language skills concurrently and longitudinally, while also taking into account the children’s sex and mothers’ education. Estonian mothers of 76 children reported their language teaching practices at child ages 3;0 and 4;0. Children’s language comprehension and production were measured via the examiner-administered New Reynell Developmental Language Scales (NRDLS). The results indicated that at Wave 1, girls scored higher on language comprehension and production than boys. Mothers’ higher education predicted higher scores on language production. Maternal corrective feedback was a negative predictor of children’s concurrent language comprehension. At Wave 2, neither maternal teaching practices, maternal education nor child’s sex predicted the language measures of interest. The longitudinal results showed that later language production scores were negatively predicted by mothers’ corrective feedback. Yet, the strongest predictors of both language scores were the scores of language comprehension and production measured 1 year earlier. Moreover, maternal language teaching practices at Wave 2 were predicted by mothers’ early language teaching practices, but not by children’s earlier language skills.

Perceived stress, family impact, and changes in physical and social daily life activities of children with chronic somatic conditions during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has inevitably affected children and their families. This study examines the impact of the COVID-19 measures in children with chronic somatic conditions (CSC) and their parents and compares them with a Dutch general population sample.MethodsWe included a sample of children with CSC (0–18 years, n = 326) and compared them with children (8–18 years, n = 1,287) from the Dutch general population. Perceived stress, coping, social interaction with friends and family, physical activity, eating behavior, family support, parenting perception, and financial situation were assessed once with the self-reported and parent-reported COVID-19 child check questionnaire, between November 2020 and May 2021. Comparisons between the two samples were made by using t-tests and chi square tests.ResultsThe proportion of children who reported being less physically active and having less social interaction with friends since the COVID-19 pandemic was higher in children with CSC than in children from the general population. Children with CSC and their parents experienced less stress than children and parents from the general population. Moreover, parents of children with CSC aged 0–7 years and parents of children aged 8–18 years from the general population experienced less support and more financial deterioration than parents of children with CSC aged 8–18 years. In the parents from the general population only, this deteriorated financial situation was associated with more stress, worse family interaction and parenting perception, and less received support.ConclusionsThe impact of COVID-19 on children with CSC and their parents differed from those in the general population. Addressing the collateral damage of COVID-19 measures in children and their families may give direction to policy and potentially prevent lifelong impact.

Development and Evaluation of Pediatric Versions of the Vanderbilt Fatigue Scale for Children With Hearing Loss.

Growing evidence suggests that fatigue associated with listening difficulties is particularly problematic for children with hearing loss (CHL). However, sensitive, reliable, and valid measures of listening-related fatigue do not exist. To address this gap, this article describes the development, psychometric evaluation, and preliminary validation of a suite of scales designed to assess listening-related fatigue in CHL: the pediatric versions of the Vanderbilt Fatigue Scale (VFS-Peds). Test development employed best practices, including operationalizing the construct of listening-related fatigue from the perspective of target respondents (i.e., children, their parents, and teachers). Test items were developed based on input from these groups. Dimensionality was evaluated using exploratory factor analyses (EFAs). Item response theory (IRT) and differential item functioning (DIF) analyses were used to identify high-quality items, which were further evaluated and refined to create the final versions of the VFS-Peds. The VFS-Peds is appropriate for use with children aged 6-17 years and consists of child self-report (VFS-C), parent proxy-report (VFS-P), and teacher proxy-report (VFS-T) scales. EFA of child self-report and teacher proxy data suggested that listening-related fatigue was unidimensional in nature. In contrast, parent data suggested a multidimensional construct, composed of mental (cognitive, social, and emotional) and physical domains. IRT analyses suggested that items were of good quality, with high information and good discriminability. DIF analyses revealed the scales provided a comparable measure of fatigue regardless of the child's gender, age, or hearing status. Test information was acceptable over a wide range of fatigue severities and all scales yielded acceptable reliability and validity. This article describes the development, psychometric evaluation, and validation of the VFS-Peds. Results suggest that the VFS-Peds provide a sensitive, reliable, and valid measure of listening-related fatigue in children that may be appropriate for clinical use. Such scales could be used to identify those children most affected by listening-related fatigue, and given their apparent sensitivity, the scales may also be useful for examining the effectiveness of potential interventions targeting listening-related fatigue in children. https://doi.org/10.23641/asha.19836154.

Intergenerational reproduction and adult self-rated physical health in China

We used cross-sectional data from the 2017 Chinese General Social Survey to investigate whether and how Chinese parents utilize their socioeconomic resources to facilitate the acquisition of socioeconomic resources by their children that in turn affect the self-rated health of the adult children. We found that father's type of work unit (danwei) and father's membership in the Chinese Communist Party were not independently associated with the self-rated health of survey respondents. Father's education was associated with the self-rated health of women, especially younger women, and self-reported childhood social class was associated with the self-rated health of men and older women, most strongly so for younger men. Two thirds of the association between father's education and self-rated health among younger women was statistically explained by personal socioeconomic resources and almost a quarter of the association between self-reported childhood social class and self-rated health among younger men was statistically explained by personal socioeconomic resources. Our study illuminates the importance of intergenerational reproduction in fostering the good health of Chinese adults, especially for those who grew up after the Chinese economic reform of the 1970s.

Travel career or childhood travel habit?: Which better explains adult travel behaviour?

This study investigates a popular theory of tourist motivation – the travel career pattern – and contrasts it against an alternative explanation – that childhood travel habits repeat throughout life. The key distinction is that the travel career pattern predicts change, whereas habit predicts repetition. This study tests competing hypotheses, using self-reported childhood and adulthood travel experiences, behaviours and motivations. Results point to childhood travel behaviour repeating as adult travel behaviour, supporting the key role of habit as a driver of travel behaviour. These findings represent a paradigm shift in our theoretical understanding of determinants of travel behaviour, which implies that habits could be used as leverage points for behavioural change in tourism.

Restraint Use for Child Occupants in Dubai, United Arab Emirates.

The overall objective of the current study was to investigate the behaviours and knowledge of parents/carers in relation to safe child occupant travel in the Emirate of Dubai in the United Arab Emirates (UAE). A community survey was completed by 786 participants who were responsible for the safety of 1614 children (aged 10 years and younger). The survey included questions related to the type, frequency and appropriateness of restraint use for their eldest child. Overall, 24 percent of participants reported that they ‘never/almost never’ restrained their eldest child while travelling in a motor vehicle, with this proportion increasing with child age. For example, though 89 percent of participants reported that they restrained their infants (<1 year) in an ‘appropriate’ restraint for their age, this rate was much lower for children aged between 5 and 7 years (10%). Overall, these findings suggest that a large proportion of child occupants, especially those aged five years and older, are not appropriately restrained in vehicles, and therefore are at an increased risk of death or serious injury in the event of a crash. Future research will validate this self-reported child restraint use data with objective data from observations of real-world child restraint use behaviour in the UAE.

Pain Catastrophizing and Functional Disability in Youth with Chronic Pain: An Examination of Indirect Effects.

Pediatric pain conditions are not uncommon and may lead to functional disability. The purpose of this study is to examine indirect effects of pain catastrophizing on functional disability through anxiety, depression, and pain in youth with chronic pain. Participants included 197 youth (144 females, Mage = 14.67years) with chronic pain conditions. Youth completed self-report measures of pain catastrophizing, depression, anxiety, pain intensity, and functional disability. Caregivers also completed a measure of youth functional disability. Using a cross-sectional design, a multiple mediator model was estimated with pain catastrophizing as the predictor, functional disability as the outcome, and depression, anxiety, and pain intensity as mediators. Results supported a mediation model in which depression (B = 0.1145, SE = 0.0528, Z = 2.1686; B = 0.1512, SE = 0.0585, Z = 2.5846) and pain intensity (B = 0.1015, SE = 0.0422, Z = 2.4052; B = 0.0634, SE = 0.0343, Z = 1.8484) significantly mediated the effects of catastrophizing on child self-report and parent-report functional disability, respectively, while anxiety (B = - 0.0260, SE = 0.0439501, Z = - 0.5923; B = - 0.0637, SE = 0.0552, Z = - 1.1540) did not. Theoretical and clinical applications are discussed.