Observational Scale Of Behavioral Distress Research Articles

Adult Command Structure and Children's Distress During the Anticipatory Phase of Invasive Cancer Procedures

In this study, we examined the ways in which adults issued commands to children (adult command structure) and children's distress during invasive cancer procedures. Forty-five children with cancer, ages 5-15 years, were videotaped during an intramuscular injection (IM) and a lumbar puncture (LP). Child distress was coded via the Observation Scale of Behavioral Distress. Adult commands were classified as specific direct, specific softened, specific phrased as question, or vague in structure. The results indicated that the relative proportion of vague commands was positively related to child distress. This apparent ineffectiveness of vague commands is consistent with the behavior management literature. In contrast, the relative proportions of specific direct commands issued by parents during IMs and specific softened commands issued by nurses during LPs were associated with lower levels of child distress. The findings suggest that clinical interventions as well as developmental models of adult-child interactions may need to be both setting and participant specific.

THE EFFECTS OF A COMPANION ANIMAL ON DISTRESS IN CHILDREN UNDERGOING DENTAL PROCEDURES

The purpose of our pilot study was to evaluate the effects of a companion animal (dog) on physiologic arousal and behavioral distress among children undergoing a dental procedure. A repeated measures experimental design was used to study 40 children between the ages of 7 and 11 years who were undergoing procedures in a pediatric dental clinic. Half the children had the dog present during the procedure and half did not. Data were obtained before, during, and after the procedure. Behavioral distress was measured using the Observational Scale of Behavioral Distress; procedures were videotaped. Physiologic arousal was measured using a YSI telethermometer taped to the child's index finger. Student's t-test and repeated measures analysis of variance were used to answer the research question. No significant differences in behavioral distress or physiologic arousal were found between experimental and control groups. Further analysis revealed that for children who initially verbalized distress on arrival at the clinic, the presence of the dog decreased physiologic arousal during the time the child was on the dental table waiting for the dentist to arrive. Further research should be conducted to verify the effect of a companion animal on initial stress experienced by children for whom the visit to the dentist is most stressful.

Companion Animals Alleviating Distress in Children

ABSTRACTPhysiological arousal and behavioral distress in children aged from two to six years undergoing a physical examination were examined with and without the presence of a companion dog. An experimental/control group, repeated measures design was utilized to study children at a pediatric clinic. Thirty-four (14 males, 20 females) children were assigned randomly either to a treatment group (n=15) in which a therapy dog was present during their examinations or to a control group (n=19) which had the usual pediatric exam without a dog present. Physiological variables (systolic, diastolic, and mean arterial pressures, heart rate, and fingertip temperatures) were measured at baseline and at two-minute intervals during each examination. Subjects were videotaped during the examination for analysis of behavioral distress using the Observation Scale of Behavioral Distress (OSBD). Physiological measurements were not statistically significantly different between the dog and no-dog groups but were found not to be good measures of physiologic arousal in this age group. There was statistically significantly less behavioral distress when the dog was present (M=0.06 in the dog group versus 0.27 in the no-dog group: F(1,32)=4.90, p=0.034). These findings replicate those of Nagengast et al. (1997) who found that the presence of a companion dog could lower the behavioral distress of children during a laboratory simulated physical examination and suggest that companion animals may be useful in a variety of health care settings to decrease procedure-induced distress in children.

A Comparison of Distractors for Controlling Distress in Young Children During Medical Procedures

Distraction is a strategy that has been shown to be effective and safe in the control of pain and distress. We assessed the utility of two simple distraction procedures for reducing children's pain and distress. Three conditions, control, brief film, and short story, were delivered during repeated medical procedures in a randomized sequence to eight young children with cancer. Scores on the Observational Scale of Behavioral Distress (OSBD-R) as well as observer ratings of overall behavioral distress showed that the short story procedure was more effective than either the control condition or the cartoon film. These results argue for the utility of simple parent–child interactive distraction tasks to ameliorate children's procedural distress.

Treatment-resistant pain and distress during pediatric burn-dressing changes.

Recent research has suggested some efficacy for the use of hypnosis in the control of pain and distress in a pediatric population undergoing painful medical procedures. Here, we study a sample (N=23) of pediatric subjects undergoing burn-dressing changes and receiving either an imagery-based or control (social-support) treatment. Subjects' levels of distress were assessed with the Observational Scale of Behavioral Distress. Results indicated that distress behaviors in this population can be measured reliably using this scale. However, no support was found for the main hypothesis that imagery treatment would be superior to control treatment in the alleviation of distress, nor were these treatments effective in comparison to baseline conditions. We discuss the formidable problem that burn and dressing-change pain presents, as well as the reasons why this treatment attempt might have failed to have the predicted effects. We also discuss important developmental considerations regarding the adequate assessment of pain and distress.

Relationships between cognitive behavioral techniques, temperament, observed distress, and pain reports in children and adolescents during lumbar puncture

A limited number of studies have examined relationships between temperament and children's/adolescents' responses to painful procedures and have identified several different dimensions of temperament that are related to children's pain response. The focus of these studies was one-time, acute pain experiences, such as immunization and postoperative pain. In this study, children and adolescents' responses to a moderately painful procedure, lumbar puncture, were examined as they related to temperament. Nineteen children and adolescents, ages 4 to 18 years, who were receiving treatment for cancer, were participants in this study. Parents completed one of three age-appropriate temperament questionnaires at the beginning of the study and prior to the parent and child learning cognitive-behavioral techniques. Behavior during the procedure was videotaped at baseline, and for up to four visits after baseline and coded using the Observation Scale of Behavioral Distress (OSBD). Pain reports were collected after the procedure using the Oucher pain self-report scale. Improvement in the level of behavioral distress was determined by examining the differences between pre- and post-treatment OSBD scores and self-reported pain ratings. There was a significant improvement in pain reports over the 5-month period, but behavioral distress did not change significantly. At the baseline visit, the temperament dimensions of more positive mood, lower activity, less persistence, and lower distractibility were related to higher pain reports, but not behavioral distress. However, after 5 months, only the dimension of positive mood was significantly correlated with improvement in pain reports. The amount of time parents and children practiced the techniques, their comfort with the techniques and their perceived effectiveness also were correlated with positive mood.

CHILDREN'S RESPONSES TO IMMUNIZATIONS: LULLABIES AS A DISTRACTION

The purpose of this study was to investigate the effects of audiotaped lullabies on physiological and behavioral distress and perceived pain among children during routine immunization. An experimental design was used to study 99 healthy children ages 3 to 6 years. Half the children received the musical intervention during the immunizations, while the other half did not. Groups were assessed during five phases: baseline, preimmunization, during the immunization, after Band-Aid application, and 2 min after phase 4. Physiological variables (heart rate, blood pressure) were obtained in phases 1, 4, and 5. Behavioral distress was measured using the Observational Scale of Behavioral Distress during phases 1, 2, 3, and 4. Pain perception was measured using the Oucher in phases 1 and 4. No significant differences were found between experimental and control groups for heart rate, blood pressure, or Oucher scores. However, total distress scores were significantly less for the experimental group. These results indicate that immunization is a stressful experience for children. Recommendations include further study incorporating pharmacological and nonpharmacological interventions.

THE EFFECTS OF A PSYCHOLOGICAL PREPARATION PROGRAM ON ANXIETY IN CHILDREN AND ADOLESCENTS UNDERGOING GASTROINTESTINAL ENDOSCOPY

Purpose: To investigate the effects of a psychological preparation program prior to gastrointestinal endoscopy on: patient self-reported anxiety, parental self-reported anxiety, observed patient anxiety, patient autonomic nervous system stimulation and dosage of medication required for procedural sedation. Methods: Sixty patients ages 5-19 yrs (mean=12.2 yrs) were randomized into one of two groups. Group 1 received routine preparation prior to endoscopy. Group 2 received psychologic preparation provided by a Child Life Specialist. Preparation consisted of demonstration of materials that would be encountered during the procedure, use of a doll as a model or book with photographs of a child who had previously undergone endoscopy. Patients in both groups completed the Spielberger State Anxiety Inventory (STAI) at the time of their clinic appointment and just prior to endoscopy. The Observational Scale of Behavioral Distress was completed by the same blinded observer during each procedure. Vital signs were recorded in clinic and just prior to endoscopy. The attending physician (blinded) assessed patient cooperation. Parents and patients completed post-endoscopy questionnaires. Results: Analysis of the STAI showed patients in Group 2 were significantly less anxious prior to endoscopy (p<0.0001). They also required less mg/kg of meperidine (p=0.04) and were more cooperative during the exam (p=0.042). There was significantly less autonomic nervous system stimulation just prior to the procedure compared to baseline in patients who had undergone psychologic intervention (change in heart rate:p<0.001; change in systolic blood pressure: p=0.040). There was no significant difference between Group 1 and Group 2 with respect to observed behavioral distress during the procedure or mg/kg of midazolam administered. Statistically significant differences were found in the patients' response to post-endoscopy questions regarding perceived procedural anxiety (p=0.003) and the parents' response to questions regarding their own condition (p=0.026) and their children's (p<0.001). Conclusion: We conclude that psychological preparation prior to endoscopy significantly decreases patient and parental anxiety. Such preparation may allow for a reduction in sedative medications and thereby enhance procedural safety.

Pain, Anxiety, and Cooperativeness in Children with Cerebral Palsy After Rhizotomy: Changes Throughout Rehabilitation

Assessed pain, anxiety, physical functioning, and cooperativeness in 32 children with spastic cerebral palsy. This is the first study to assess children throughout rehabilitation following selective posterior rhizotomy. Results of the Observational Scale of Behavioral Distress and observer Likert ratings confirmed the hypothesis that children's pain and anxiety decrease over time. Children's physical functioning and cooperativeness improve over time. No significant correlation was found between pain and changes in physical functioning. Cognitive impairment, parental involvement, and children's pain behaviors explained 77% and 56% of the variance in two forms of cooperativeness. Research and clinical implications are discussed, and special considerations regarding pain assessment and management in this population are addressed.

Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children

Study Objective: To determine the frequency of 5% halothane induction and behavioral distress during inhalation induction with both oral midazolam and parental presence compared with parental presence alone. Design: Randomized, controlled, double blind study. Setting. Same day anesthesia at a university department of anesthesiology. Patients: 72 ASA status I and II children, 3 to 10 years of age, scheduled for first time anesthesia. Interventions: Children were assigned to one of two groups to receive midazolam 0.5 mg/kg orally or placebo. A parent was present during induction. Children were videotaped at baseline, after treatment, and during induction. Tapes were scored for behavioral distress using the revised Observational Scale of Behavioral Distress. Measurements and Main Results: Children who received midazolam in the setting of parental presence had significantly fewer 5% halothane inductions than those who received placebo ( p < 0.02). They also had less behavioral distress ( p < 0.01). Conclusions: The combination of parental presence plus oral midazolam reduces the likelihood of needing a 5% rapid halothane induction when compared with parental presence without premedication.

The Behavioral Approach-Avoidance and Distress Scale: an investigation of reliability and validity during painful medical procedures.

Validated the use of the Behavioral Approach-Avoidance and Distress Scale (BAADS; Hubert, Jay, Saltoun, & Hayes, 1988), which was reported to be easily completed and scored in an analog situation, for measuring children's distress and coping style during actual painful medical procedures. 60 preschool children who were receiving immunizations at a health department were subjects. Objective measures (Observational Scale of Behavioral Distress and Child-Adult Medical Procedure Interaction Scale-Revised) and subjective measures (child-, parent-, and nurse-report) were used. Results of the current study support the internal consistency and concurrent validity of the Distress subscale of the BAADS; however, some caution is suggested in interpreting the Approach-Avoidance subscale. Discussion focuses on the utility of this scale in clinical settings and the cost-effectiveness of this measure for assessing pediatric patients.

Physician and parent behavior during invasive pediatric cancer procedures: relationships to child behavioral distress.

Observed 51 children with cancer, their parents, and their physicians during routine bone marrow aspirations and lumbar punctures. Child distress was measured via the Observational Scale of Behavioral Distress (OSBD); adult behaviors were coded via the Child Adult Medical Procedure Interaction Scale (CAMPIS). In general, physicians were less verbally interactive than parents both before and during the procedure. As expected, several parent behaviors were positively related to child distress. However, physician behaviors were uniformly negatively related to child distress. Findings are discussed in terms of the physician-patient relationship and the possible role of physicians as change agents in reducing child distress during invasive procedures.

Helping preschool leukemia patients and their parents cope during injections.

Taught 4 preschool leukemia patients (ages 3-5) to engage in specific coping behaviors before and during painful intramuscular and intravenous injections. Parents were taught to coach their children in the use of the coping behaviors. Intervention was delivered in a multiple baseline across-subjects design. Parent and child behavior was coded using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R, Blount, Powers, & Sturges) and Observation Scale of Behavioral Distress (OSBD, Elliott, Jay, Woody). Parents and nurses rated child behavior as well. Results indicated that parents learned coping-promoting behaviors, children learned specific coping behaviors, and children displayed less behavioral distress. Maintenance of behavior change was addressed. Contributions of this study to the current literature on children's coping with invasive medical procedures and implications for future research and clinical practice are discussed.

Oral Ketamine Premedication to Alleviate the Distress of Invasive Procedures in Pediatric Oncology Patients

This study prospectively evaluated the efficacy of oral ketamine in alleviating procedure-related distress in pediatric oncology patients. Ketamine (10 mg/kg) was administered orally to 35 children and adolescents, ranging in age from 14 months to 17 years (mean = 6.5 years). Procedure-related distress was evaluated by using parent/clinician ratings and the Observational Scale of Behavioral Distress (OSBD-R). Eighty-seven percent of children were sedated within 45 minutes. Clinician and parent ratings were similar, with 77% rating procedural distress as low (0 to 3). The OSBD-R scores were low throughout all phases of the study. Although this study was neither randomized nor placebo-controlled, statistical comparison of the OSBD-R scores of the patients who received oral ketamine with those of historical controls (from a study previously performed at the same institution but using intravenous midazolam) showed significantly less distress (P < .001) during the procedure in children who received oral ketamine. Additionally, OSBD-R scores of the patients who received oral ketamine were significantly lower (P < .001) during all phases than those of the saline placebo group in the other study. No cardiorespiratory side effects related to ketamine were noted. The majority of patients showed recovery from sedation within 2 hours following the procedure. In conclusion, oral ketamine effectively alleviated procedure-related distress in pediatric oncology patients.

Sequential Patterns of Medical Stress:

Fifty-seven 4-10-year-old pediatric medical clinic patients and their mothers were observed while awaiting a diagnostic examination. The Dyadic Prestressor Interaction Scale (DPIS) was used to assess mother and child behaviors. Child distress during the examination was measured by the Observational Scale of Behavioral Distress (OSBD). Lag sequential analysis indicated that when mothers who self-reported high state anxiety (STAI) exhibited agitation, child distress (DPIS) increased (p < .05). The reverse sequence, an increase in maternal agitation following child distress (DPIS), occurred among low anxious mothers (p < .005). Additionally, irrespective of state anxiety, mothers who became agitated following DPIS child distress, had children who during the exam showed high OSBD distress (p < .01). Results indicate the importance of mother-child interactions as a factor in children's medical stress.