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Objective: Randomized-controlled trials (RCTs) in pediatric psychology form the foundation for evidence-based treatment and best practices in the field. Relying heavily on continuous outcome measures and group comparisons, questions concerning meaningful clinical change and treatment response rates remain open. This targeted review aimed to provide an initial description of the current state of intervention research in pediatric psychology in terms of attention to meaningful clinical change and efforts to assess and characterize participants in terms of treatment responsivity.Methods: Online databases were used to identify a sample of RCT published in the Journal of Pediatric Psychology from 2010 to 2021 using the term "randomized" in the title. Using predefined eligibility and exclusion criteria, 43 studies were identified and analyzed with regard to characteristics of intervention, population, measurement, data reporting, and reference to indicators of clinical significance, meaningful change, treatment responsivity rates, and predictors.Results: 26 studies (60%) made no reference at all to meaningful clinical change, treatment response criteria and rates, or characteristics of treatment responders. 15 studies (35%) reported measures of meaningful change in their interpretation of group differences, to calculate sample size, in relation to baseline data only, or in describing a measure. 2 studies (5%) reported criteria for assessing meaningful change to determine individual response rates and characteristics of responders.Conclusions: These findings highlight the need for greater emphasis on defining standards and analyzing treatment outcome research in terms of metrics of meaningful change and treatment response in order to better target intervention and optimize limited resources. [ABSTRACT FROM AUTHOR]

Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n = 213) or UPC plus 8 sessions of PSST (PSST; n = 217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.

Chemotherapy, used for treating cancer, can cause severe side effects such as nausea and vomiting and is found by many patients to greatly disrupt their lives. In younger cancer patients, the side effects associated with chemotherapy are a major cause of noncompliance with treatment. Many of these younger patients develop anticipatory side effects before treatment, meaning that they develop the nausea and vomiting in anticipation of the effects treatment will have. A number of strategies have been tried with these patients to lessen the side effects of chemotherapy and their perceived disruptiveness so as to increase compliance with treatment. Hypnosis has been used, as have active mind-distracting techniques such as playing video games. This study examined which type of treatment to relieve the distress of chemotherapy was most effective in young patients. A total of 54 cancer patients aged 5 to 17 were randomly placed in one of three treatment groups: 21 received hypnotic therapy while undergoing chemotherapy, 16 received support before chemotherapy on distractive and relaxation techniques, and 17 received no specific treatment beyond conversation with a therapist (the control group). Results showed that nausea from chemotherapy lasted a significantly shorter time in both the hypnosis group and the distraction/relaxation group compared with the control group. The duration of vomiting was significantly shorter for the hypnosis group than for the control group. Overall symptom scores improved 31 percent in the hypnosis group and 13 percent in the support group over time, but worsened in the control group by 50 percent. These results indicate that hypnosis may be highly effective in treating the distress associated with chemotherapy and its side effects in young people. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: Bright IDEAS (BI) is a problem-solving skills training (PSST) program that has been demonstrated in earlier randomized controlled trials (RCTs) to be an effective and specific intervention for improving problem-solving skills and reducing negative affect in caregivers of children with cancer. The objectives of this study were to (a) offer an approach to defining meaningful treatment response and to determine the rates of responsivity to PSST; and (b) identify characteristics of PSST responders and nonresponders.Methods: Data from 154 mothers receiving the BI intervention were analyzed. Drawing on the literature on minimal clinically important differences, two criteria for determining responsivity were calculated for the primary outcome of problem-solving skills: (a) The reliable change index (RCI) based on group data, and; (b) The effect size (ES) of each participant's pre/postintervention change score as a function of the group's baseline SD.Results: Thirty-three percent of the sample met both responsivity criteria immediately posttreatment (39% at follow-up) and 38% (39% at follow-up) met neither. An additional 29% demonstrated a small or greater ES (≥ 0.2) but did not meet the RCI criteria, suggesting possible benefit. The single consistent predictor of responsivity was participants' pretreatment problem-solving skills, with lower skills at baseline predicting greater improvement (p < .001).Conclusions: These findings highlight the need to go beyond group data in interpreting RCTs and to incorporate measures of meaningful treatment response. Our ability to predict and screen for meaningful treatment response is critical to more precise targeting, enhanced outcomes, and better resource allocation. [ABSTRACT FROM AUTHOR]

Objective: To examine negative affectivity and problem-solving abilities for lone mothers and those who are married/partnered subsequent to a child's diagnosis with cancer.Methods: Negative affectivity and problem-solving strategies were assessed for 464 mothers (87 lone and 377 married/partnered) within 2-16 weeks of their child's diagnosis with cancer.Results: The two groups of mothers did not differ significantly on measures of perceived posttraumatic stress or problem-solving; lone mothers reported significantly more symptoms of depression. This difference was no longer significant when maternal education was taken into account.Conclusions: Negative affectivity and problem-solving abilities were similar for lone mothers and those that are married/partnered shortly after their child has been diagnosed with cancer. Findings are discussed within the context of contemporary strategies to assess marital status as proxy variable for various underlying constructs. [ABSTRACT FROM AUTHOR]

Abstract. The purpose of this study was to assess prospectively the behavioral effects of chemotherapy in children and adolescents with cancer. A total of 94 patients, with a range of malignancies and chemotherapy protocols, were evaluated 1, 4, and 7 months after treatment initiation. Assessments focused on behavioral distress symptoms and nausea/vomiting experienced in anticipation of chemotherapy and following its administration. Significant disturbances were described in a variety of domains, with adolescents exhibiting consistently higher levels of behavioral symptoms and nausea/vomiting than younger children. Behavioral distress tended to decrease and stabilize throughout time for children and to increase throughout time for adolescents. Age differences in behavioral distress were independent of the emetogenicity of therapy given to younger and older patients. The interaction of biologic and psychosocial factors in determining treatment-related distress is discussed, along with implications for future predictive and intervention studies. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the prevalence and correlates of anticipatory nausea and vomiting in a sample of pediatric patients with cancer who were receiving outpatient chemotherapy. Forty male and female patients representing a broad range of diagnoses were interviewed with their parents concerning nausea and vomiting before and after chemotherapy. Anticipatory nausea was reported by 28.8% of the sample; anticipatory vomiting was present in 20% of the sample. An additional 9% had experienced anticipatory nausea and vomiting in the past but not currently. Anticipatory nausea and vomiting was positively correlated with the emetic potential of chemotherapeutic regimens and the severity of nausea and vomiting after chemotherapy; anticipatory nausea and vomiting most often developed within the first 4 months of treatment. Onset of anticipatory nausea and vomiting usually occurred two to four hours before treatment and was most severe at the actual time of drug administration. Considerable interpatient variability was observed, with treatment-related factors accounting for only 22% of the variance in the occurrence of anticipatory nausea .and vomiting. These findings are considered within a behavioral framework for understanding conditioned aversions in pediatric patients with cancer. Implications for patient education, future research on the prediction of children at risk, and intervention are discussed. [ABSTRACT FROM AUTHOR]