Alexandra L. Quittner - US grants

The purpose of the current study is to develop a measure of situation- specific stressors and coping strategies for chronically ill children and their parents. Prior research on stress an coping has been limited by the use of poorly defined constructs and a failure to consider contextual factors such as the severity of the stressor and the developmental tasks of the individual and family. To ameliorate these inadequacies, the proposed study will employ a situational analysis of the specific problems and demands associated with chronic childhood illness and normal development. The specific objectives of study 1 are: 1) to assess the problems and coping behaviors of two developmental cohorts of children with cystic fibrosis (CF) and their parents, 2) To develop empirically-derived ratings of the effectiveness of specific coping strategies for particular problems, and 3) To examine relationships among problem severity, choice of coping strategies, and functional outcomes. Sixty children with CF (30 school age and 30 adolescents) and their parents from Riley Hospital for Children, Indiana University Medical Center and Children's Hospital of Pittsburgh, Pittsburgh University School of Medicine will participate in Study 1. Structured interviews, daily diaries and standardized questionnaires will be used to develop the inventory of problem situations. Ratings of the competence of various coping strategies will be derived from judgments of children with CF, parents, and health care professionals. Following construction of the problem inventory and raters manual, Study 2 will employ a two-wave longitudinal design with the following objectives: 1) To assess the criterion-oriented validity of the measure, 2) To test the mediating effects of coping behaviors on the frequency and severity of specific problems and related outcomes, and 3) To assess the impact of discrepancies in perception of stress and use of coping strategies among family members. Sixty adolescents with CF and their parents from Riley Hospital for Children will be asked to complete the problem inventory, standardized questionnaires, and the Activity Pattern Indicators at two points over a 6-8 month period. By linking problems directly to effective coping behaviors for both the child and family, this study will provide the basis for developing preventive behavioral interventions.

An RCDA is requested to support a comprehensive research program examining effects of chronic childhood illness on the social and behavioral development of children, siblings, and parents. Childhood illness is conceptualized as a major perturbation of the family system, providing an opportunity to study how families resolve ongoing problems, how developmental transitions are affected by chronic stress, and how families reorganize roles and relationships given greater demands on time and energy. Four major studies will be conducted: 1) development of a measure of problematic situations and coping strategies for chronically- ill school-age and adolescent children and their parents, 2) a three-wave longitudinal validation of the adolescent-parent measure of coping efficacy, 3) a diary study of sibling relationships, parental differential treatment, and social support, and 4) a diary study examining role strain in couples raising a chronically ill vs. healthy child. The theoretical framework guiding this research is the need for greater contextual specificity in the definitions and measurement of stress and coping processes. Studies funded by a FIRST Award apply a behavior-analytic model to identify both the specific tasks and situations that are problematic for children and adolescents with cystic fibrosis and the most effective coping efforts. In contrast, prior research has been limited by the use of global, poorly defined constructs. This research also seeks to advance theory by moving away from the study of individuals toward the evaluation of relationships within family systems; the extent of congruence among family members in perceptions of problems and use of coping strategies will be related to outcomes such as family conflict. An RCDA would greatly enhance my development as a researcher by enabeling me to obtain training in: 1) Dynamical systems theory and methods, 2) Intensive observational techniques, and 3) Development and evaluation of preventive interventions for chronically ill children and their families. The family system is a complex one and will require new models and data analytic techniques to represent its nonlinear pattern of interactions. Dr. Smith will advise me in the application of dynamical systems theory to the proposed diary methods. DR. Corsaro, an expert on qualitative data collection methods with children, will provide supervision in this area. The IU Diabetes Research and Training Center will instruct me in the design and implementation of interventions for adolescents and their families, and will assist in adapting my measures to their population. Additional training in intervention methods will be provided by Drs. La Greca and Sandler. This research should advance understanding of the effects of chronic stress on children and families, in addition to providing the basis for developing preventive behavioral interventions. Finally, an RCDA will enable me to obtain critical training experiences from an eminent group of researchers to facilitate my growth as a theorist and researcher.

DESCRIPTION: More than two decades of research have documented the risks associated with chronic illness for both adolescents and their families, including high rates of noncompliance with medical treatment and an increased incidence of behavioral and emotional distress. Despite this evidence and the importance of these problems for long-term health outcomes, the development and evaluation of family interventions for adolescents who have a chronic illness are extremely rare. A major reason for the lack of intervention research is the global level at which key constructs, such as stress and coping, have been measured. The principal investigator's program of research over the past four years has focused on the development of situation-specific measures for adolescents with cystic fibrosis (CF) and their parents that can be used to target issues for intervention and evaluate subsequent change. The central goal of this project is to compare the effects of two empirically validated interventions, Family Education (FE)and Behavioral-Family Systems Therapy (BFST), to standard medical care. BFST has shown promise in reducing conflict and increasing communication skills in families of adolescents with a variety of disorders, including diabetes, anorexia, and attention-deficit disorder. The proposed study would be the first evaluation of structured interventions for adolescents with CF and their parents. CF is the most common, fatal genetic disease of Caucasian populations, primarily affecting the lungs and pancreas. It requires a complex, time-consuming daily medical regimen (chest physiotherapy, alterations in diet) that places great demands on adolescents and their parents. The proposed study is a multi-site, randomized controlled trial these interventions on: 1) adherence to medical treatment, 2) family conflict, communication, and skills, and 3) long-term health outcomes (pulmonary functioning, morbidity). These outcomes will be measured using physiological (wrist actigraphs, inhaler meters), observational (videotaped family diaries, role-play assessments of coping skills), and self-report (reports of adolescents and their parents at two major CF centers will be groups. It is hypothesized that, relative to the other groups, families in the BFST group will show more positive effects on these outcome measures.

This proposal is to establish funding for five two-year post doctoral trainees in pediatric psychology research. Trainees will be assigned to one of five preceptors (or research mentors) and will have immediate access to a number of interdisciplinary research collaboration from clinical psychology, pediatrics, behavioral pediatrics, psychiatry, and health services administration. In addition to research mentors and collaborators, an internal training committee and an advisory board have been established. The development of this training program is consistent with the recent national movement toward increased post-doctoral specialization. Several factors have contributed to the development of the current program proposal. First, the pre-doctoral pediatric psychology training program at the University of Florida is well developed and has an outstanding national reputation. Second, collaborative research relationships are well established throughout the University of Florida Health Science Center. Third, pediatric psychologists in the Department of Clinical and Health Psychology repeatedly receive requests from pediatricians for research projects that would lend themselves well to the skills of a post-doctoral trainee. Fourth, pediatric psychology researchers at the University of Florida have access to large pediatric populations in virtually all areas of medicine. Fifth, there are several pediatric populations that have gone largely unserved from a research perspective. Sixth, the overall quality and productivity of the proposed program's faculty are very high.

[unreadable] DESCRIPTION (provided by applicant): This application seeks funding for the Applied Developmental Psychology Training program (ADPT) at the University of Miami. This program focuses on the development of knowledge concerning the psychosocial risk factors associated with developmental disabilities, especially those risk factors endemic to children raised in poverty. While the ADPT provides opportunities for concentrated studies in major syndromes, such as autism, the main emphasis is on understanding lesser degrees of retardation or disability (e.g., learning disabilities, mild MR, language delay) that account for a large and growing proportion of people with significant developmental difficulties. Many of the ADPT research activities occur in hospitals, schools and private agencies within the community. These graduate training experiences equip students to function effectively in a wide variety of multi-ethnic and multicultural settings that are increasingly encountered in metropolitan areas of our country. The ADPT faculty is multidisciplinary, with members from Psychology, Pediatrics and Education. The focus of the training ranges from the use of epidemiological methodology to quantify risk and risk reduction to the development of new techniques for early identification of children with developmental disabilities and the development of new intervention approaches toward ameliorating the effects of multiple risk factors, biological and social insults to development, and the assessment of the effectiveness of early interventions for infants and children with mental retardation and developmental disabilities, and those at high risk for these developmental problems. The facilities available to ADPT are diverse and include the Mailman Center for Child Development, the Linda Ray Children's Center a community based facility dedicated to research and training with infants and toddlers who are at risk for DD through substance exposure and the allied effects of abuse and neglect, and the Center for Autism and Related Disabilities, which provides opportunities for research and training on autism Asperger's syndrome, and other related disabilities. [unreadable] [unreadable] [unreadable]