Browsing by Subject "Pediatric"
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Item Attrition and body mass index change in pediatric weight management: the predictive value of demographic and mental health variables(2016-08) Lotz, Elijah John Strong; Keith, Timothy, 1952-; Gray, Jane; Pont, Stephen; Stark, Kevin; Rodriguez, ErinChild and adolescent obesity has increased dramatically in the last few decades, and remains a pressing health concern in the United States. Responding to the problem of obesity in youth has been a challenge, as body mass index (BMI) change is difficult to attain, and attrition from pediatric weight management programs is often very high. The purpose of the current study was to identify demographic and mental health variables that can predict attrition and BMI change in a pediatric weight management program using multiple linear regression and binary logistic regression. Participants were children and adolescents with obesity 6-18 years of age and their parents living in the central Texas area and participating the a hospital-based multidisciplinary pediatric weight management program. Results provided several significant findings. Rates of attrition from the intervention were similar to findings from prior research. No study variables significantly predicted dropout prior to the third visit. However, parent’s preferred language, taking psychiatric medication at the first visit, and symptoms of inattention were all significant predictors of dropout prior to the fourth visit. In paired-samples t- tests, unstandardized BMI scores increased significantly from first to last visit, while BMI z-scores decreased significantly. Average time between visits significantly predicted unstandardized BMI change and BMI z-score change in this sample. Last visit number was also a significant predictor of unstandardized BMI change. Implications, limitations, and areas of future research are discussed.Item Cerebellar tumor location as a predictor of neurocognitive functioning among survivors of pediatric brain tumors(2016-12) Mitchell Von Buttlar, Ashlee Beth; Allen, Greg, doctor of clinical psychology; Greenspahn, Emily SThe literature has clearly demonstrated that the cerebellum serves as a major processing center in the brain for many complex functional pathways ranging from attention and learning to emotions and affect. Research is now emphasizing the importance of connectivity between the cerebellum and other brain regions, and has begun highlighting the need to understand the impact of damage to distinct regions on functional pathways throughout the brain. One particular type of cerebellar damage, caused by posterior fossa tumors, has received substantial attention in the medical and neuropsychological literature in recent years. Tumors of the posterior fossa, which includes the cerebellum and brain stem structures, account for over 15% of brain tumors in children. Due to advances in treatment, survival rates have increased dramatically for individuals with posterior fossa tumors, leading to a greater need for long-term medical and psychosocial care. Treatments for these tumors, including chemotherapy and cranial radiation, are known to produce long-term deficits in a variety of neurocognitive domains. These deficits are referred to as “neurocognitive late effects,” and can be seen as impaired performance in the areas of attention, memory, executive functioning, visual-spatial processing, and processing speed. Neurocognitive late effects can be especially pronounced in patients with localized cranial radiation, as is common with malignant brain tumors. Research has clearly shown that different regions of the cerebellum uniquely contribute to various neurocognitive functions. Additionally, much research has assessed the neurocognitive implications of posterior fossa tumors in children. However, little work has examined the unique relationship between specific tumor locations within the cerebellum and later neurocognitive outcomes. The purpose of this document is to propose a study to determine whether the particular location of tumors in the cerebellum can predict neurocognitive functioning in the domains of attention and executive functioning in children with these tumors.Item An exploration of parental, nurse, and physician perceptions of family-centered care and the pediatric surgical process(2012-08) Calfa, Nicolina Ann; McCarthy, Christopher J.; Lawson, Karla; Drum, David; Jones, Barbara; Tharinger, DeborahThe purpose of this study was to assess parental and medical staff perceptions of the implementation of family-centered care during the surgical process at a pediatric hospital. Both children and parents experience hospitalization as a stressful process often characterized by painful, frightening medical procedures, interactions with strangers, and a loss of control and decision-making abilities. Medical staff members can play a vital role in alleviating parental distress by providing clear and consistent communication, support, and collaboration with parents throughout their child’s hospital care and recovery. Therefore, this study specifically sought to examine parental and medical staff members’ perceptions of the provision and importance of three types of social support: informational, emotional, and instrumental. This study also sought to examine the relationship between parental perceived provision and importance of social support and parental perceived stress. Qualitative questions were utilized to gather additional information regarding parents’ and medical staff members’ experiences throughout the surgical process. The sample for this study included 117 parents of surgical patients and 51 medical staff members (nurses, surgeons, and anesthesiologists) at a pediatric hospital in the southwestern United States. The quantitative data were analyzed using Mann-Whitney U Tests, Kruskal-Wallis Tests, and correlational analysis. Qualitative data were examined to identify major themes that have supported and contrasted with the quantitative results. The findings of this study revealed statistically significant differences between the perceived provision and importance of social support types among participant groups. Results also indicated statistically significant associations between parental perceptions of the provision and importance of social support type and parental perceived stress. These significant findings serve to inform care for families during the surgical process and guide future research in this area.Item The impact of a blended cognitive remediation and cognitive behavioral group therapy for pediatric oncology survivors : a mixed methods approach(2013-08) Judd-Glossy, Laura Elizabeth; Stark, Kevin DouglasAdvances in cancer treatment have led to a significant increase in the number of pediatric oncology survivors. These survivors often have late effects in their cognitive, academic, executive, and psychological functioning subsequent to their chemotherapy and radiation treatment. In particular, executive functioning (EF), which is crucial for cognitive and academic functioning, has been recognized as an area that is impacted by treatment. Several studies have described cognitive remediation programs that seek to improve EF skills in pediatric oncology survivors. Although these programs have led to improvements in EF skills, they are often difficult to replicate due to the extensive time requirement. Many survivors also experience distress and anxiety and would likely benefit from cognitive behavioral therapy, which has been shown to be an effective intervention for children with internalizing disorders. Thus, a brief intervention that combines treatment for executive functioning and psychological distress is warranted. A mixed methods study was conducted to evaluate the impact of a nine-week blended cognitive remediation and cognitive behavior therapy group for pediatric oncology survivors and their parents. Participants were pediatric cancer survivors, age 9-14, and their parents who were referred through a local children's hospital that specialized in oncology treatment. Pre and post measures of EF, psychological functioning, and parental stress were examined. Semi-structured interviews with participants and their parents were completed and analyzed to learn more about the function of short-term group therapy for pediatric oncology survivors. Content analysis of the parent support group sessions was also conducted. Significant changes were found for youth internalizing symptoms, youth adaptive skills, youth executive functioning, and parental stress. There was also a positive correlation between parental stress and parent-rated youth internalizing problems as well as parent-rated youth behavioral symptoms and a negative correlation between parental stress and parent-rated youth adaptive behavior. Qualitative interviews indicated that participants felt that the intervention was helpful. Themes from the parent group included the challenge of managing late effects, balancing multiple roles, and coping with distress. Implications, limitations, and recommendations for further areas of research are presented.Item Making an informed decision : oral motor treatment in pediatric dysphagia(2011-05) Thompson, Amy Lynn; Marquardt, Thomas P.The purpose of this report is to review critically research focused on oral motor based treatment for pediatric swallowing disorders with the aim of assisting speech-language pathologists in making informed clinical intervention decisions. Oral motor based treatment has become a popular intervention approach among some speech-language pathologists, but the evidence supporting the approach is limited. This report will discuss research studies and review articles with high levels of evidence of treatment efficacy and propose when to use oral motor based treatment approaches in clinical intervention for pediatric swallowing disorders.Item Processing speed and executive function in pediatric acute lymphoblastic leukemia survivors(2012-12) Garrison, Daniel Alexander; Carlson, Cindy I., 1949-; Robillard, Rachel WestThis study examined processing speed and executive function late effects in survivors of pediatric ALL (hereafter referred to as Survivors). Late effects are long-term, treatment-related health problems associated with the neurotoxic side-effect of cancer treatment on brain development. Processing speed —mental and motor speed with which a person can solve nonverbal problems — was estimated via an composite of processing speed attained from several measures of processing speed. Executive function — a collection of processes orchestrated in the performance of purposeful, goal-directed behavior — was measured using the Parent and Teacher forms of the Behavior Rating Inventory of Executive Function (BRIEF). This study also explored the effect of previously identified risk factors for processing speed and executive function late effects. Finally, executive function late effects were further explored via the use of performance-based measures, including the Tower and Trail Making (Condition 4) tests of the Delis-Kaplan Executive Function System (D-KEFS). Hypotheses included (1) Survivors would demonstrate significantly poorer processing speed; (2) late effects risk factor variables (i.e., greater elapsed time since completion of treatment, lower age at diagnosis, and higher intensity of treatment) would predict poorer processing speed; (3) female gender would predict poorer processing speed; (4) parents and teachers would demonstrate both low interrater agreement (Hypothesis 4a) and differ significantly in the severity (Hypothesis 4b) of their ratings of Survivor executive function; (5) parent and teacher ratings of executive function would indicate significantly poorer Survivor metacognition (Hypothesis 5a), whereas Survivor behavioral regulation would not differ significantly (Hypothesis 5b); (6) risk factor variables would predict poorer Parent and Teacher ratings of Survivor metacognition; (7) female gender would predict poorer Parent and Teacher ratings of Survivor metacognition; (8) survivor processing speed and Parent and Teacher ratings of executive function would exhibit a positive relationship; and (9) poorer Survivor processing speed would predict poorer parent and teacher ratings of executive function. Results provided support for hypothesis 1 and 5a. Partial support was obtained for hypotheses 4a, 4b, and 7. Hypotheses 2, 3, 5b, 6, 8, and 9 were not supported.