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Objective The aim of this study was to examine whether maternal parenting behaviors (i.e., warmth, behavioral/psychological control) moderate the association between central nervous system (CNS)-directed treatment and adjustment among pediatric cancer survivors at 3 years post-diagnosis or relapse. Methods Three years after their child’s cancer diagnosis or relapse, mothers (N = 84) reported on their child’s academic and social competence, as well as their internalizing and externalizing problems. Children (N = 84; Mage = 13.21 years, 52.4% male) reported on maternal parenting behaviors. Using medical chart data, children were separated into CNS (i.e., received cranial radiation, intrathecal chemotherapy, and/or neurosurgery; N = 45) or non-CNS-directed treatment (N = 39) groups. Twelve moderation models were tested when examining two-way interactions between CNS treatment group and maternal parenting behaviors. Results Children in the CNS-directed treatment group demonstrated significantly worse academic and social competence. Moderation analyses revealed four significant two-way interactions between CNS treatment group and maternal parenting behaviors when predicting children’s adjustment. High levels of maternal behavioral control buffered the negative impact of CNS-directed treatment on children’s social competence. In addition, maternal warmth had a contrasting effect, as CNS-directed treatment was associated with worse academic competence at high levels of warmth. Analyses with psychological control revealed that low levels of this parenting style were not protective against internalizing or externalizing problems among those with CNS-directed treatment. Conclusions Children who receive CNS-directed treatment may benefit from a different pattern of parenting during early cancer survivorship. Findings highlight the importance of considering the broader family context when conceptualizing the impact of illness-related factors on adjustment among pediatric cancer survivors.

ObjectiveChildren diagnosed with cancer experience stress associated with their diagnosis and treatment and are at heightened risk for problems in social adjustment. This study investigated the association between coping with cancer-related stress and problems in social adjustment across the first year after a pediatric cancer diagnosis.MethodsMothers of children (ages 5–17 years) with cancer (N = 312) were recruited from two children’s hospitals. Mother’s reported on their child’s social adjustment and coping near diagnosis (T1) and 12 months (T2).ResultsPrimary, secondary control, and disengagement coping were significantly associated with concurrent social adjustment at 12 months. The bivariate associations between baseline primary and secondary control coping and social problems 12 months later were no longer significant in a multivariate regression model.ConclusionsThese findings inform our understanding of the association between coping with cancer-related stress and social adjustment of children diagnosed with cancer. Interventions teaching primary and secondary control coping strategies for cancer-related stressors may offer some benefit to concurrent youth social adjustment. Further research is needed on how best to support social adjustment in this population over time.

Objective To provide a comprehensive quantitative review of biological, environmental, and behavioral correlates across domains of cognitive function in sickle cell disease (SCD). Methods Forty-seven studies were identified in PubMed, MedLine, and PsycINFO involving 2573 participants with SCD. Results Meta-analytic findings across all identified samples indicate that hemoglobin and hematocrit were positively correlated with Full Scale IQ [FSIQ; r = .15, 95% confidence interval (CI) = .10 to .21], language and verbal reasoning (r = .18, 95% CI = .11 to .24), and executive function (r = .10, 95% CI = .01 to .19) with small effects and significant heterogeneity. Transcranial Doppler velocity was negatively associated with visual spatial and perceptual reasoning (r = −.18, 95% CI = −.31 to −.05). Socioeconomic status was positively associated with FSIQ (r = .23, 95% CI = .17 to .28), language and verbal reasoning (r = .28, 95% CI = .09 to .45), visual spatial and perceptual reasoning (r = .26, 95% CI = .09 to .41), and executive function (r = .18, 95% CI = .07 to .28) with small to medium effects. Finally, total behavioral problems were negatively associated with FSIQ (r = −.12, 95% CI = −.21 to −.02) such that participants with lower FSIQ exhibited greater behavioral and emotional problems. Conclusions Findings provide evidence for biological, environmental, and psychosocial corelates across multiple domains of cognitive function in SCD. More research on more specific cognitive domains and psychosocial correlates is needed in addition to assessments of interactional models among risk factors.

Objective Despite surgical palliation, children with hypoplastic left heart syndrome (HLHS) have compromised cardiac functioning and increased risk for cognitive deficits. We quantitatively reviewed the empirical data from this literature. Methods The present meta-analysis included 13 studies reporting cognitive function for children with HLHS between the ages of 2 years and 6 months and 17 years that used standardized assessments of Full Scale IQ (FSIQ), Verbal IQ (VIQ), and Performance IQ (PIQ). Differences in cognitive function were assessed relative to normative data, and we examined sample mean age and publication year as moderators. Results Large effects were found for FSIQ (g = −.87, 95% CI [−1.10, −.65], M = 86.88) and PIQ (g = −.89, 95% CI [−1.11, −.68], M = 86.56), and a medium effect was found for VIQ (g = −.61, 95% CI [−.84, −.38], M = 90.82). All models demonstrated significant heterogeneity. Meta-regression analyses of effect size via Hedges’ g on child age revealed a significant effect on FSIQ (coefficient = −.07, 95% CI [−.12, −.01], p < .01, R2 = .40) indicating a loss of 1.1 FSIQ points across studies with each increased year of mean sample age. Conclusions Deficits in FSIQ may reflect chronic brain injury or failure to make expected gains as children age. This review highlights the importance of early intervention in this population, and the need for longitudinal studies analyzing more specific domains of cognitive function and potential moderators.

Objective This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.

Objective The current study examined the effect of stress on sibling conflict during the first year of pediatric cancer treatment. Method Families (N = 103) included a child with cancer (aged 2-17 years, Mage = 6.46, SD = 3.52) and at least one sibling aged

Objective The objective of this study was to investigate the association between cognitive functioning, coping, and depressive symptoms in children and adolescents with sickle cell disease (SCD). Method Forty-four children (M age = 9.30, SD = 3.08; 56.8% male) with SCD completed cognitive assessments measuring working memory (Wechsler Intelligence Scale for Children-Fourth Edition) and verbal comprehension (Wechsler Abbreviated Scale of Intelligence-Second Edition). Participants' primary caregivers completed questionnaires assessing their child's coping and depressive symptoms. Results Verbal comprehension was significantly positively associated with secondary control coping (cognitive reappraisal, acceptance, distraction), and both working memory and secondary control coping were negatively associated with depressive symptoms. In partial support of the primary study hypothesis, verbal comprehension had an indirect association with depressive symptoms through secondary control coping, whereas working memory had a direct association with depressive symptoms. Conclusions The results provide new evidence for the associations between cognitive function and coping, and the association of both of these processes with depressive symptoms in children with SCD. Findings provide potential implications for clinical practice, including interventions to improve children's cognitive functioning to attenuate depressive symptoms.

Objectives To examine parent-child communication (i.e., openness, problems) and child adjustment among youth with advanced or non-advanced cancer and comparison children. Methods Families (n = 125) were recruited after a child's diagnosis/relapse and stratified by advanced (n = 55) or non-advanced (n = 70) disease. Comparison children (n = 60) were recruited from local schools. Children (ages 10-17) reported on communication (Parent-Adolescent Communication Scale) with both parents, while mothers reported on child adjustment (Child Behavior Checklist) at enrollment (T1) and one year (T2). Results Openness/problems in communication did not differ across groups at T1, but problems with fathers were higher among children with non-advanced cancer versus comparisons at T2. Openness declined for all fathers, while changes in problems varied by group for both parents. T1 communication predicted later adjustment only for children with advanced cancer. Conclusions Communication plays an important role, particularly for children with advanced cancer. Additional research with families affected by life-limiting conditions is needed.

Objective Children with sickle cell disease (SCD) are at increased risk for cognitive impairment as a result in part from biological characteristics of the disease; however, limited research has explored possible social and contextual factors associated with risk for cognitive problems. The primary aim of the present study was to examine the relation between children’s cognitive functioning and responsive parenting, a potentially important contextual factor in children with SCD, accounting for family socioeconomic disadvantage, child disease severity, and caregivers’ perceived stress. Methods Forty-eight children completed standardized cognitive assessments and caregivers provided self-reports of general and disease-related stress. Parent–child dyads completed a video recorded puzzle-solving task and observed parenting was quantified using two coding systems. Bivariate Pearson correlations were used to assess preliminary hypotheses, and linear multiple regression analyses were used to assess the primary hypothesis. Results Results suggested that increased levels of parental stress were related to fewer observations of responsive parenting and provided evidence of an association between children’s cognitive function and responsive parenting. Specifically, increased disease-related parent stress and reduced parental use of expansive language were associated with significantly lower cognitive functioning in children with SCD. Conclusions Findings suggest that social environmental factors along with disease characteristics are sources of risk for cognitive problems with children with SCD. Further, these findings highlight the need to develop targeted interventions for parents of children with SCD to decrease levels of stress and enhance parenting skills, with the aim improving cognitive functioning in youth.

Objective To provide a comprehensive quantitative review of neurocognitive function in sickle cell disease (SCD) across multiple domains, cerebral infarct status, and the lifespan. Methods One hundred and ten studies were identified in PubMed, MedLine, and PsycINFO involving 110 studies of 3,600 participants with SCD and 1,127 sibling or health controls. Results Meta-analytic findings indicate significant deficits across all neurocognitive domains, age groups, and infarct status. Significant deficits relative to the normative mean ranged from Hedges’ g = −.39 to g = −.63 in preschool children, g = −.83 to g = −1.18 in school-aged children and adolescents, and g = −.46 to g = −.86 in adults. Deficits in full scale IQ (FSIQ), verbal reasoning, perceptual reasoning, and executive function increased from preschool to school-aged samples. However, findings also showed that deficits were smaller in adult samples relative to school-aged samples, likely due to sampling bias in adult studies. Findings across infarct status in sickle cell anemia showed that deficits ranged from g = −.54 to g = −.65 in samples without infarcts, g = −.52 to g = −1.03 in samples with silent cerebral infarct, and g = −1.35 to g = −1.82 in samples with stroke. Deficits in each domain increased in magnitude from no infarct or stroke, to silent cerebral infarct, to overt stroke. Conclusion Individuals with SCD are at risk for cognitive deficits across domains, infarct status, and the lifespan. More research is necessary to determine unbiased effects for cognitive function in adults with SCD.

More than 12,000 children are diagnosed with cancer each year in the United States, and it is the second leading cause of death in children (Jemal, Siegel, Xu, & Ward, 2010). Although survival rates for these children continue to increase, children with cancer and their parents are faced with numerous challenges at diagnosis and throughout treatment (Rodriguez et al., 2012; Wijnberg-Williams, Kamps, Klip, & Hoekstra-Weebers, 2006). One of the greatest challenges facing parents is how to talk with their child about the disease, treatments, side effects, and prognosis. Research on other illnesses, such as type 1 diabetes (Jaser & Grey, 2010), asthma (Lim, Wood, Miller, & Simmens, 2011), and cystic fibrosis (DeLambo, Ievers-Landis, Drotar, & Quittner, 2004), indicates that positive parental communication is linked to children’s positive psychosocial adjustment and disease management, including lower rates of emotional and behavioral problems and higher adherence. Informational resources for parents of children with cancer also highlight the importance of positive communication (http://www.cancer.gov/cancertopics/coping/youngpeople/page4; http://www.cancer.net/patient/Coping/Relationships+and+Cancer/How+A+Child+Understands+Cancer). However, some parents of children with cancer may have difficulty putting these recommendations into practice without guidance, especially if they are distressed, and empirical research is lacking on how to help parents communicate effectively. Despite its potential importance, previous research on parent–child communication about cancer is limited. First, most studies have only examined communication during medical procedures (Cline et al., 2006; Dahlquist, Power & Carlson; 1995). Second, studies that have examined parent–child communication about cancer more broadly have been limited by small samples and qualitative analyses, and none have used observational methods (Clarke, Davies, Jenney, Glaser, & Eiser, 2005; Young, Dixon-Woods, Windridge, & Heney, 2003). Quantitative analyses are a necessary next step in providing empirically supported recommendations for intervention, and observational methods reduce the likelihood of methodological confounds with self-reported adjustment. Therefore, quantitative analyses and the use of direct observations of parent–child communication can provide more rigorous tests of the hypothesized relations between communication and adjustment. In addition to the limitations noted previously, studies with pediatric populations have typically emphasized broad macro-level indicators of communication (see Alderfer et al., 2008, for a review). At a macro level, measuring parent–child communication involves rating the overall quality of parental characteristics or behaviors (e.g., warmth, responsiveness, intrusiveness, permissiveness). Macro-level observational analyses code the overall frequency and intensity of the behaviors throughout an interaction (Melby & Conger, 2001) but do not quantify the frequency of specific behaviors or the sequence of behaviors between parents and children. In contrast, micro-level analyses require observational data that are coded to evaluate whether a specific response or aspect of communication has occurred and to count how many times it occurs over the course of an interaction. Micro-level analyses have been used extensively to study discourse pragmatics (i.e., how parents direct or manage conversations with their children; Lasky & Klopp, 1982) and parental responsiveness (e.g., studies of “dyadic synchrony”; see Harrist & Waugh, 2002, for a review). Research on parent–child communication in pediatric psychology overwhelmingly has used macro-level analyses (Dunn et al., 2011; Lim et al., 2011), whereas research in developmental psychology often relies on micro-level analyses (Hart & Risley, 1992; Raikes & Thompson, 2008). However, research that integrates macro and micro levels of analysis can strengthen findings, illuminate mechanisms of effect, and provide specific targets for intervention. For example, Holmbeck et al. (2003) found that children with spina bifida used more validations and recanting, which was consistent with macro-level findings that indicated these children were less controlling and more dependent. Integrative analyses such as these may identify micro-level aspects of parent–child discourse that are associated with global measures of parental behaviors (e.g., warmth), which may be teachable communication skills for parents of children with cancer. As such, the first aim of this study was to examine associations between micro- and macro-level communication coding systems. A major goal of these analyses was to identify aspects of maternal communication that are associated with positive or negative global communication styles, so that future research may specifically examine these micro-level behaviors in relation to child psychosocial outcomes and target these behaviors during interventions. Parents’ communication with their children about cancer may be affected by parents’ distress after diagnosis. Mothers of children with cancer often experience elevated levels of depressive symptoms after their children are diagnosed (Bruce, 2006; Dunn et al., 2012). Research with other pediatric populations suggests that mothers’ depressive symptoms may negatively impact parent–child communication, and that poorer maternal communication impacts child adjustment (Jaser & Grey, 2010; Lim et al., 2011). However, no study has examined the relations between depressive symptoms and observed mother–child communication about cancer. Given the increased risk for depressive symptoms in these mothers and the impact that maternal depression and communication may have on child adjustment and family functioning, research is needed to understand the relationships between depressive symptoms and communication about cancer. Therefore, the second aim of this study was to test if higher maternal depressive symptoms were associated with poorer maternal communication about cancer with their children. The current study examined associations between macro- and micro-level aspects of mothers’ communication and maternal depressive symptoms in a sample of children with cancer and their mothers. The scope of the current study was limited to maternal depressive symptoms and communication rather than child behaviors and outcomes to provide a more in-depth examination of multiple levels of maternal communication. The macro-level indicators were positive and negative communication, which were coded using a well-established, well-validated macro-coding system. The micro-level indicators were developed for the current study and included topic maintenance (i.e., whether the mother maintained the topic of conversation of the child’s preceding utterance) as well as the type of maternal response (i.e., whether it was a reflection, reframe, expansion, disclosure, solicit, provision of information, imperative, or validation; see Table I for definitions). Based on previous studies showing that maternal contingency is associated with positive parenting behaviors (Harrist & Waugh, 2002) and that imperatives are associated with negative parenting behaviors (Aragona & Eyberg, 1981), we hypothesized that more topic maintenance, reflections, expansions, and validations, and fewer imperatives, would be associated with higher levels of positive communication and lower levels of negative communication. In accordance with the second aim of testing whether maternal depressive symptoms predicted communication, we hypothesized that higher levels of maternal depressive symptoms would be positively associated with higher levels of maternal negative communication and lower levels of maternal positive communication. Finally, in accordance with the goal of identifying discrete targets for psychosocial intervention, we conducted regression analyses to examine if depressive symptoms and select micro-level codes contributed unique variance in predicting mothers’ macro-level positive and negative communication. If we found that the association between macro- and micro-level aspects of communication was not solely accounted for by the relationship with depressive symptoms, this finding would suggest that micro-level communication skills (e.g., reflections) could be taught to modify macro-level patterns of communication (e.g., positive communication) independent of depressive symptoms. Table I. Definitions, Examples, Descriptive Statistics, and Psychometric Properties of CCS and IFIRS Codes

Objectives To compare peer relationships among bereaved siblings and matched classmates, and to examine gender, grade level, and time since death as moderators. Methods Families were recruited from cancer registries at four hospitals 3–12 months after a child's death. Measures of social behavior and peer acceptance were completed by children in the classrooms of 105 bereaved siblings (ages 8 –17 years). Teachers also reported on children's social behavior. Three classmates were matched for gender, race, and age to each bereaved sibling to form a comparison group (n = 311). Results Teachers reported bereaved siblings were more prosocial than comparison classmates. Peers perceived bereaved boys as more sensitive-isolated and victimized, while bereaved siblings in elementary grades were perceived by peers as less prosocial, more sensitive-isolated, less accepted, and as having fewer friends. Peers and teachers viewed bereaved siblings in middle/high school grades as higher on leadership–popularity. Conclusions Bereaved siblings who were male and in elementary grades were more vulnerable to social difficulties, while those in middle/high school may exhibit some strengths. Ongoing research to inform the development of interventions for bereaved siblings is warranted.

Objective To examine the acceptability and feasibility of coding observed verbal and nonverbal behavioral and emotional components of mother–child communication among families of children with cancer. Methods Mother–child dyads (N ¼ 33, children ages 5–17 years) were asked to engage in a videotaped 15-min conversation about the child’s cancer. Coding was done using the Iowa Family Interaction Rating Scale (IFIRS). Results Acceptability and feasibility of direct observation in this population were partially supported: 58% consented and 81% of those (47% of all eligible dyads) completed the task; trained raters achieved 78% agreement in ratings across codes. The construct validity of the IFIRS was demonstrated by expected associations within and between positive and negative behavioral/emotional code ratings and between mothers’ and children’s corresponding code ratings. Conclusions Direct observation of mother– child communication about childhood cancer has the potential to be an acceptable and feasible method of assessing verbal and nonverbal behavior and emotion in this population.

Objective To examine the role of executive function in coping and behavioral outcomes in childhood acute lymphocytic leukemia (ALL) survivors. Methods We examined associations among several domains of executive function (working memory, behavioral inhibition, cognitive flexibility, and self-monitoring), coping, and emotional/behavioral problems in 30 children and adolescents ages 10- to 20-years old who completed treatment for ALL and 30 healthy controls matched on age and sex. Results We found partial support for our hypothesis that performance on executive function measures is associated with strategies used to cope with stress, and emotional and behavioral problems in ALL survivors. Conclusions Findings suggest that executive function impairment may be associated with difficulties in coping and emotion regulation in a subgroup of children treated for ALL. Directions for future research on executive function deficits and coping skills in survivors of pediatric ALL are suggested.

Objective To review research on observed family communication in families with children with chronic illnesses compared with families with healthy, typically developing children, and to integrate findings utilizing a unifying family communication framework. Method Topical review of studies that have directly observed family communication in pediatric populations and included a typically developing comparison group. Results Initial findings from 14 studies with diverse approaches to quantifying observed family communication suggest that families with children with chronic illnesses may demonstrate lower levels of warm and structured communication and higher levels of hostile/intrusive and withdrawn communication compared with families with healthy, typically developing children. Conclusion An integrative framework of family communication may be used in future studies that examine the occurrence, correlates, and mechanisms of family communication in pediatric populations.

Objective This study sought to identify possible associations between maternal coping and depression and subsequent mother-child communication about cancer following the child's diagnosis. Method Mothers (N = 100) reported on coping and depressive symptoms shortly after the child's diagnosis (M = 1.9 months). Subsequently, we observed children (age 5-17 years; M = 10.2 years; 48% female; 81% White) and mothers discussing cancer and coded maternal communication. Results Higher primary and secondary control coping, and lower depressive symptoms, were generally correlated with more positive, and less harsh and withdrawn communication. In regression models, higher primary control coping (i.e., coping efforts to change the stressor or one's emotional reaction to the stressor) independently predicted less withdrawn communication, and depressive symptoms mediated relations between coping and harsh communication. Conclusions Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.

OBJECTIVES: To test whether children with recurrent abdominal pain (RAP) exhibit subliminal (nonconscious) and supraliminal (conscious) attentional biases to pain-related words, and to determine correlates of these biases. Previous research indicates that individuals attend to disorder-relevant threat words, and in this study, attentional biases to disorder-relevant threat (pain), alternative threat (social threat), and neutral words were compared. METHODS: Participants were 59 children with RAP who completed a computer-based attentional bias task. Participants and their parents also completed questionnaires measuring pain, somatic complaints, anxiety/depression, and body vigilance. RESULTS: Children with RAP showed attentional biases toward subliminal pain-related words and attentional biases away from supraliminal pain-related words. Participants' attentional biases to social threat-related words were marginally significant and also reflected subliminal attention and supraliminal avoidance. Attentional biases were related to parent and child reports of pain, body vigilance, and anxiety/depression. CONCLUSIONS: Children with RAP show nonconscious attention to and conscious avoidance of threat-related words. Their attentional biases relate to individual differences in symptom severity. Implications for models of pediatric pain and future studies are discussed. Language: en

The diagnosis and treatment of childhood cancer present numerous challenges and sources of stress for children and their parents (Kupst & Bingen, 2006). Despite general agreement that cancer and its treatment can be stressful for families, more information is needed on the cancer-specific stressors that affect mothers, fathers, and children, how stressful they report these stressors to be, and how these stressors are associated with their adjustment to the disease and its treatment, particularly in children. Research on the nature, frequency, and correlates of cancer-related stressors experienced by children with cancer and their parents may provide important information regarding individual differences in risk for psychological distress and psychosocial interventions to help manage these stressors. Several studies have examined sources of stress for parents of children with cancer. For example, Kazak and Barakat (1997) administered a general measure of parenting stress and found that higher levels of parenting stress were related to higher levels of posttraumatic stress symptoms (PTSS). Other studies have examined sources of stress directly associated with having a child with an illness using the Pediatric Inventory for Parents (PIP; Streisand, Braniecki, Tercyak, & Kazak, 2001). The PIP includes four domains of stressors related to caring for a child with a chronic illness, including communication, emotional functioning, medical care, and role function. In a sample of parents of children with cancer, Streisand et al. (2001) found that levels of stress on the PIP did not differ as a function of parental gender, marital status, education, employment status, or household income; however, the level of stress reported by parents was inversely correlated with child age. Another study with a pediatric cancer sample in the Netherlands found that higher PIP scores were correlated with younger child age, and mothers reported higher levels of stress than fathers (Vrijmoet-Wiersma et al., 2010). The finding that mothers may have higher levels of stressors is also consistent with research indicating that mothers have higher rates of cancer-related PTSS than fathers (Bruce, 2006). Several studies have also found that higher levels of parental stressors on the PIP were related to higher levels of psychological distress in parents of children with cancer (Streisand et al., 2001; Streisand, Kazak, & Tercyak, 2003; Vrijmoet-Wiersma et al., 2010). Additional research has also examined cancer-specific perceived stressors and psychological distress in childhood cancer survivors and their mothers using the Impact of Traumatic Stressors Interview Schedule (ITSIS), a semi-structured interview that measures cancer-related stressors relevant to childhood survivors of cancer and their parents in several domains, including distress, changes in perception of self, communication, and vigilance (Kazak et al., 2001; Kazak, Stuber, Barakat, & Meeske, 1996). Reports and perceptions of cancer- and treatment-related events as traumatic stressors on the ITSIS were positively associated with reports of PTSS and internalizing problems (Kazak et al., 1996, 2001). Fewer studies have focused on stressors faced by children with cancer, and most of these studies have used general measures of life stress. For example, Currier, Jobe-Shields, and Phipps (2009) examined stressful life events that were not directly related to the child’s cancer, and found that they predicted PTSS in these children. Brown, Madan-Swain, and Lambert (2003) examined stressful life events unrelated to cancer in childhood cancer survivors and found that they reported more recent and past stressful events than healthy controls. In contrast, some studies have focused directly on cancer-related stressors for children undergoing treatment (e.g., Hockenberry-Eaton, Kemp, & Dilorio 1994; Varni & Katz, 1997) or off-treatment (e.g., Kazak et al., 1996, 2001). Findings from these studies have been mixed, as some studies suggested that cancer-related stressors were not associated with children’s physiological distress (Hockenberry-Eaton et al., 1994), while others found that perceived stressors were associated with higher levels of negative affect (Varni & Katz, 1997) and PTSS (Kazak et al., 2001; Kazak et al., 1996). Further, no studies with a pediatric cancer sample have measured cross-informant (e.g., parents and children) correlations of reports of children’s stressors. Research and theory in developmental psychopathology and pediatric psychology has highlighted the importance of obtaining reports from the self and others for both children and adults (e.g., Achenbach, 2006, 2010; Felder-Puig, Topf, Gadner, & Formann, 2008). Significant cross-informant correlations have been found for emotional and behavioral symptoms in children, with small effects for parent–child cross-informant reports and larger effects for mother–father reports of children (Achenbach, McConaughy, & Howell, 1987). Therefore, we expected that parent–child reports of children’s stressors would be moderately associated and mother–father reports of children’s stressors would be more strongly associated. In general, there is relatively little research that describes which types or domains stressors are most salient and what types of stressors are most stressful to children with cancer and their parents. To address this gap and guided by research and theory on the importance of considering specific domains and sources of stress in children and adolescents (e.g., Grant et al., 2003; McMahon, Grant, Compas, Thurm, & Ey, 2003), the current study examined cancer-related stressors in a sample of children with first diagnoses of cancer or relapsed disease and their parents. Similar to the domains of stress included on the PIP (Streisand et al., 2001), we examined stressors faced by mothers and fathers of children with cancer in several domains: daily role functioning, cancer communication, and cancer caregiving. Recent theory and research on stress has highlighted the role of the “tend-and-befriend” response that engages caretaking behaviors in parents and is heightened in women as compared with men (e.g., Han-Holbrook, Holbrook, & Haleston, 2011; Taylor & Master, 2011). We also extended this work by examining child self-reports and parents’ reports of children’s stressors in the domains of daily role functioning, physical effects of treatment, and uncertainty about cancer. Further, we examined how cancer-related stressors in these families were related to general perceived stress and PTSS, as previous research specifically indicates that PTSS may be elevated in these parents (e.g., Bruce, 2006; Kazak, Boeving, Alderfer, Hwang, & Reilly, 2005) and that higher levels of stressors may be related to higher levels of PTSS (e.g., Kazak & Barakat, 1997). With regard to stressors faced by parents, we hypothesized: (a) mean levels of cancer-related stressors would be higher for mothers than fathers; (b) mothers’ and fathers’ levels of stressors would be positively correlated; and (c) higher levels of cancer-related stressors experienced by mothers and fathers would be positively correlated with levels of general perceived stress, younger child age, and higher levels of PTSS. We also conducted exploratory analyses comparing the different subdomains of stress (role functioning, communication, and caregiving) for mothers and fathers. We hypothesized that with regard to stressors faced by children with cancer: (a) cross-informant reports (children’s, mothers’, and fathers’ reports) of children’s stressors would be positively correlated, and (b) higher levels of children’s cancer-related stressors would be positively correlated with higher levels of PTSS. In addition, we explored the question of whether the mean levels of cancer-related stressors for children differed across informants (i.e., children, mothers, and fathers), and whether higher levels of stress for children were associated with family income and child age. We also conducted exploratory analyses comparing subdomains of stressors (role functioning, physical effects, and cancer uncertainty) for children.

Objective To examine the extent to which stress, coping, and temperament accounted for variability in adjustment among children with cancer. Methods Seventy-five mothers of children with cancer (ages 5–17) completed questionnaires regarding their child's cancer-related stress; coping; temperament characteristics including positive affect (PA), negative affect (NA), and effortful control (EC); and symptoms of anxiety and depression. Assessments occurred within one year of initial diagnosis or relapse (M = 5.74 months; SD = 4.72). Results Cancer-related stress was positively associated with symptoms of depression in children. NA was positively associated with symptoms of anxiety and depression. Primary control coping moderated the association between NA and depression, and primary and secondary control coping mediated this association. Conclusion Results partially support the utility of an integrated model including cancer-related stress, coping, and NA in identifying children at risk for internalizing symptoms during treatment. Additional research is needed to inform interventions for this population.

To examine the chronic illness literature and evaluate the impact on single parenting and children and adolescents with chronic illness.We conducted literature reviews of relevant research pertaining to single-parent families on PubMed, Medline, and PsychINFO and also surveyed pertinent book chapters and all of the articles from the Journal of Pediatric Psychology since 1987 for articles, specifically examining the potential associations of single (lone) parenting versus two-parent households on children's psychosocial functioning and the impact of the child's illness on caregiver functioning.While the literature has examined and discussed the stressors associated with parenting a child with an illness, including the impact of illness on finances, family roles, and caregiver burden, few studies have examined single parents of children and adolescents with chronic illnesses and related stressors stemming from being a lone caregiver.There is a dearth of studies examining the association between lone parenting and psychosocial functioning among children and adolescents with chronic illnesses. Specific questions necessitating future investigation are summarized and recommendations are made for future research in this important area of inquiry.

Objective: To examine relationships among coping, stress responses, pain, somatic symptoms, and anxious/ depressed symptoms in a sample of children and adolescents with recurrent abdominal pain (RAP). Method: We assessed parents’ reports of coping and involuntary responses to stress in relation to pain, somatic symptoms, and symptoms of anxiety and depression in a sample of 174 children and adolescents with RAP. Results: Based on parent reports, children’s primary control engagement coping (e.g., problem solving, emotional modulation) and secondary control engagement coping (e.g., acceptance, distraction, positive thinking) in response to pain were associated with fewer somatic complaints and symptoms of anxiety and depression; secondary control engagement coping was also associated with less pain. Involuntary engagement (e.g., physiological reactivity, rumination) and disengagement (e.g., escape, inaction) responses to pain were associated with more somatic symptoms and higher levels of anxiety and depression. Conclusions: We highlight implications of these findings for understanding processes of coping and stress reactivity in children with RAP.