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Context: Pain is a poorly managed aspect in fibrous dysplasia/McCune-Albright syndrome (FD/MAS) because of uncertainties regarding the clinical, behavioral, and neurobiological underpinnings that contribute to pain in these patients. Objective: Identify neuropsychological and neurobiological factors associated with pain severity in FD/MAS. Design: Prospective, single-site study. Patients: Twenty patients with FD/MAS and 16 age-sex matched healthy controls. Intervention: Assessments of pain severity, neuropathic pain, pain catastrophizing (pain rumination, magnification, and helplessness), emotional health, and pain sensitivity with thermal quantitative sensory testing. Central nervous system (CNS) properties were measured with diffusion tensor imaging, structural magnetic resonance imaging, and functional magnetic resonance imaging. Main outcome measures: Questionnaire responses, detection thresholds and tolerances to thermal stimuli, and structural and functional CNS properties. Results: Pain severity in patients with FD/MAS was associated with more neuropathic pain quality, higher levels of pain catastrophizing, and depression. Quantitative sensory testing revealed normal detection of nonnoxious stimuli in patients. Individuals with FD/MAS had higher pain tolerances relative to healthy controls. From neuroimaging studies, greater pain severity, neuropathic pain quality, and psychological status of the patient were associated with reduced structural integrity of white matter pathways (superior thalamic radiation and uncinate fasciculus), reduced gray matter thickness (pre-/paracentral gyri), and heightened responses to pain (precentral, temporal, and frontal gyri). Thus, properties of CNS circuits involved in processing sensorimotor and emotional aspects of pain were altered in FD/MAS. Conclusion: These results offer insights into pain mechanisms in FD/MAS, while providing a basis for implementation of comprehensive pain management treatment approaches that addresses neuropsychological aspects of pain. [ABSTRACT FROM AUTHOR]

Researchers now recognize that affluent youth experience tremendous achievement pressures, yet contributing factors or outcomes are rarely explored. Using a sample of affluent adolescents, the present study investigates the mediating role of goal orientation (GO) on relations between school motivational climate (MC) and adolescent adjustment. Adolescents from four high schools completed measures of MC (i.e., Performance and Mastery), GO (i.e., Ego and Task), and adjustment (i.e., depressive symptoms, anxiety, and life satisfaction). Performance climates were associated with more adjustment problems while Mastery climates were associated with fewer adjustment problems. Adolescents with higher Ego orientation reported more depressive and anxiety symptoms, while adolescents with higher Task orientation indicated fewer depressive symptoms and greater life satisfaction. Adolescent Task orientation mediated the relations between Mastery climate and two adjustment outcomes (i.e., depressive symptoms and life satisfaction). Results suggest the importance of non-competitive achievement-oriented values and collaborative school contexts in adolescent adjustment. (Contains 4 tables and 1 figure.)

The current study examined the curvilinear links between involvement in organized activities (OA) and sport activities specifically and various indicators of psychological and social development. Participants included 150 9th and 10th graders (57% females) from an urban, selective-enrollment high school. Eligibility for admission is based on city residence, high GPA, and high scores on standardized tests and an admission exam. Findings indicated that benefits of OA involvement leveled off at approximately 5-7 h/week, with diminishing returns for adolescents participating in more than 10 h/week. Results also suggest that OA involvement uniquely impacts male and lower-income participants. Males reported threshold effects in terms of perceived friendship competence and depressive symptoms. Male sport participants and lower-income adolescents reported a similar pattern for loneliness. Findings suggest that among a high achieving sample of urban adolescents, social and psychological benefits are linked to moderate but not intense involvement in OAs and sports. (Contains 2 tables and 5 figures.)

Objective: To develop and evaluate a portion plate for adolescents (Nutri-plate). Methods: Sixteen African American adolescents (mean age = 12.94 years; 66% male) were randomized to participate in either plate design or nutrition education sessions. Adolescents' input was used to create the Nutri-plate, and participants' food selection and intake was evaluated. Results: Adolescents indicated the plate should include simple yet colorful visual and textual information about healthful eating. Participants left less food on their plate when dining with the Nutri-plate as compared with a plain plate (P less than 0.01). Examination of effect sizes suggested that when using the Nutri-plate, participants selected less food overall (d = 0.73), more fruit (d = -0.64), more broccoli au gratin (d = -0.85), and less steamed broccoli (d = 0.87). Participants with higher body mass index selected a greater amount of healthful food when using the Nutri-plate (P less than 0.05). Conclusions and Implications: Further evaluation is needed to determine the influence of a portion plate on adolescents' nutritional behaviors. (Contains 1 figure and 1 table.)

The current cross-sectional study investigated the links between various dimensions of organized activity involvement and depressive symptoms, loneliness, and peer victimization in an ethnically and economically diverse sample of adolescents (N = 152; 58% female). Results indicate that adolescents who were involved in organized activities for more years also reported lower levels of loneliness. There was evidence of diminishing returns when adolescents were very highly involved in organized activities; those who were either under- or over-involved reported the highest levels of depressive symptoms. Conversely, findings indicate that adolescents who participated in a narrow or wide range of activity contexts reported the lowest levels of depressive symptoms. In addition, results suggested that the relation between organized activity involvement and adjustment differs among adolescents from diverse ethnic and socioeconomic backgrounds. Findings from the current study also underscore the importance of considering multiple indices of activity involvement when assessing its association with adjustment.

Objective: Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators.Methods: Youth (N = 253) aged 8-21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes.Results: Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (β = -.02 [CI = -0.07, -0.01] for SOP and β = -.02 [CI = -0.06, -0.003] for SPP) and less functional disability (β = -.06 [CI = -0.13, -0.01] for SOP and β = -.06 [CI = -0.14, -0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (β = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator.Conclusions: Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain. [ABSTRACT FROM AUTHOR]

Objective: To use the biopsychosocial model and current literature to clarify conceptual underpinnings between chronic pain and perfectionism in youth, provide recommendations for assessment and treatment of co-existing perfectionism and chronic pain conditions, and suggest a research agenda.Methods: Current literature is used to identify biopsychosocial factors common between pediatric chronic pain and perfectionism, preliminary research findings are presented, and suggestions are made for research that will help inform inclusion and adaptations of assessment tools and interventions to address perfectionism.Results: Biopsychosocial factors that may contribute to the observed relationship between chronic pain and perfectionism seen in many youth are identified. For example, cognitive factors known to be associated with perfectionism (e.g., rumination) may also contribute to pain-related catastrophizing and disability. Biopsychosocial factors may serve as mediating variables between perfectionism and pain-related outcomes among youth with chronic pain and their parents.Conclusions: Research assuming a biopsychosocial perspective is needed to clarify observed links between chronic pain and perfectionism in youth. Findings related to the characterization of perfectionism in pediatric chronic pain will inform how assessment and treatment tools can better identify and address perfectionism. [ABSTRACT FROM AUTHOR]

Intensive pain rehabilitation programs for children with chronic pain are effective for many patients. However, characteristics associated with treatment response have not been well documented. In this article we report trajectories of pain and functional impairment in patients with chronic pain up to 1 year after intensive pain rehabilitation and examine baseline factors associated with treatment response. Patients (n = 253) with chronic pain and functional disability were assessed at 5 time points (admission, discharge, 1-month, 4-month, and 12-month follow-ups). Individual trajectories were empirically grouped using SAS PROC TRAJ. For functional disability, 2 groups emerged: treatment responders (88%) and nonresponders (12%). Using a binomial logistic regression model to predict disability trajectory group, no baseline variables were significant predictors for the disability trajectory group. For pain, 3 groups emerged: early treatment responders (35%), late treatment responders (38%), and nonresponders (27%). Using multinomial regression analyses to predict pain trajectory group, older age, higher pain scores, fewer social difficulties, higher anxiety levels, and lower readiness to change were characteristics that distinguished nonresponders from responders; no significant predictors distinguished the late responders from the early responders. These results provide key information on the baseline factors that influence intensive pain rehabilitation outcomes, including risk factors that predict treatment nonresponse. Our findings have implications for developing more targeted treatment interventions.Perspective: Deriving groups of individuals with differing treatment response trajectories stimulates new thinking regarding potential mechanisms that may be driving these outcomes. [ABSTRACT FROM AUTHOR]