Adolescents who perceive greater caregiver responsibility, particularly around direct management tasks, engage in better diabetes management. Implications of these findings include designing interventions that encourage and sustain caregiver responsibility through adolescence and make explicit the contribution of caregivers.

The PAID-T and P-PAID-T are valid, reliable, and useful measures of diabetes-specific distress for teenagers with type 1 diabetes and parents of teenagers.

Objective Children with type 1 diabetes and their parents face daily self-care demands, leading to diabetes-specific emotional distress. A standardized measure of diabetes distress can guide clinical care and prevent negative outcomes. Methods This study evaluated the psychometric properties of child-and parent-report measures of the Problem Areas in Diabetes Scale, adapted for children ages 8-12 (PAID-C) and their parents (P-PAID-C). Participants were from 42 diabetes camps in the United States. Children (N ¼ 804; mean age ¼ 10.3 6 1.1) and parents (N ¼ 968) completed measures of diabetes distress, diabetes-related strengths, and self-care skills. Half of the sample was used for exploratory factor analyses (EFA) with direct oblimin rotation and the other half for confirmatory factor analyses (CFAs). Results For the PAID-C, EFA and CFAs supported an 11-item two-factor measure, Cronbach's a ¼ .91, accounting for 54.6% of the variance. For the P-PAID-C, analyses resulted in a 16-item measure, Cronbach's a ¼ .92, accounting for 51.9% of the variance. PAID-C and P-PAID-C scores were positively correlated with HbA1c (r child ¼ .08, p ¼ .04; r parent ¼ .18, p < .001), and negatively correlated with diabetes-related strengths (r child ¼ À.38, p < .001, r parent ¼ À.29, p < .001) and parent report of child self-care skills (r parent ¼ À.13, p < .001; r child ¼ À0.07, p ¼ ns). Conclusions Initial psychometrics suggest that the PAID-C and P-PAID-C reliably and validly capture diabetes-specific emotional distress for children and their parents. Associations with glycemic control, self-care, and diabetes strengths demonstrate criterion validity. Both measures have potential applications for routine, clinic-based assessments of diabetes distress and may guide clinical decision-making.

Objective Toevaluate feasibility and estimate effect sizes of omega-3 fatty acids (Ω3), individual-family psychoeducational psychotherapy (PEP), their combination, and moderating effects of maternal depression and psychosocial stressors in youth with depression. Method In a pilot 2X2 randomized controlled trial, 72 youth (ages 7-14; 57% Caucasian, 57% male) with major depression, dysthymia, or depression not-otherwise-specified were randomized to 12 weeks of Ω3, PEP+placebo, Ω3+PEP, or placebo. Ω3 vs. placebo was double-masked. Evaluators masked to condition assessed depressive severity at baseline (randomization), and 2, 4, 6, 9, and 12 weeks using the Children’s Depression Rating Scale-Revised. Results Side effects were either absent or mild. PEP was administered with 74% fidelity. Remission was: 77%, Ω3+PEP; 61%,PEP+placebo;44%,Ω3; 56%, placebo. Intent-to-treat analyses found small-to medium effects of combined treatment (d = .29) and Ω3 monotherapy (d =.42),but negligible effect for PEP+placebo (d<.10), all comparedto placebo alone. Relative to placebo, youth with fewer social stressors responded better to Ω3 (p=.04), PEP (p=.028), and their combination (p = .035), and those with maternal depression responded better to PEP (p=.020) than did those without maternal depression. Conclusion Remission rates were favorable compared to other studies of psychotherapy and comparable to an existing RCT of Ω3; results warrant further evaluation in a larger sample.Ω3 was well-tolerated. Active treatments show significantly more placebo-controlled depression improvement in the context of maternal depression and fewer stressors, suggesting they may benefit depression with a more endogenous than environmental origin.

A variable linking caregiver psychological distress to adolescent glycemic control is perceived caregiver burden around diabetes management. Implications for clinical practice include targeting caregiver psychological functioning and reducing global and diabetes-specific distress.

Objective: This pilot study evaluates efficacy of omega-3 fatty acid supplementation (O3), individual family psychoeducational psychotherapy (IF-PEP), and their combination in youth with subsyndromal bipolar disorders (bipolar disorder not otherwise specified [BP-NOS], cyclothymic disorder [CYC]). Methods: This study was a 12 week, randomized trial of O3 versus placebo and IF-PEP versus active monitoring (AM) using a 2 · 2 design (O3 + PEP: n = 5; O3 + AM: n = 5; placebo + PEP: n = 7; placebo + AM: n = 6). Twenty-three youth ages 7-14 with BP-NOS or CYC were recruited via community advertisements and clinician referrals. Participants could be taking stable medication for attention-deficit/hyperactivity disorder and sleep aids, but no other psychotropics. Independent evaluators assessed participants at screen, baseline, and 2, 4, 6, 9, and 12 weeks. Primary outcome measures were the Kiddie Schedule for Affective Disorders (K-SADS) Depression (KDRS) and Mania (KMRS) Rating Scales, Children's Depression Rating ScaleRevised (CDRS-R), and Young Mania Rating Scale (YMRS). O3/placebo conditions were double-blind; independent evaluators were blind to psychotherapy condition.

Objective Youth with chronic illness are at higher risk for psychosocial difficulties, leading to a call for screening via patient-reported outcomes (PROs). The purpose of the current review is to summarize PRO implementation in pediatric medical specialty settings. A literature review of PRO implementation in these settings, conceptual issues, value and approach, legal and ethical concerns, as well as a case example of PROA in type 1 diabetes are presented. Methods A systematic review was conducted to identify relevant articles published since the most recent Journal of Pediatric Psychology Special Issue on Evidence-Based Assessment in Pediatric Psychology (2008). Results Thirty-two articles were identified and reviewed. The majority of studies reported that PROA was feasible, did not disrupt clinic flow, identified psychosocial issues warranting intervention, and was acceptable to families and providers. Response to elevated scores and impact on behavioral health referrals varied. Conclusion While many evidenced-based assessment measures are well-validated within pediatric chronic illness groups, the literature regarding implementation of PROs is still emerging. Research findings are promising, with PROs being feasible, acceptable, and leading to increased discussion of psychosocial issues when integrated into pediatric medical settings. Additional research is needed to evaluate the longitudinal impact of PROs and the optimal manner of responding to assessment data, particularly when clinically-elevated. Ultimately, identifying psychosocial issues in pediatric medical settings can promote optimal health and well-being of youth with chronic illness and their families.

Technology use is associated with lower adolescent distress than lower parent distress. CGM Alone is associated with lower adolescent and parent distress than CSII or CGM+CSII. This appears to be clinically meaningful based on cut scores for measures. CGM is associated with lower A1c independent of being used alone or with CSII.