Abstract:Using a multitrait-multimethod approach, measures designed to assess emotional distress in medical populations were compared with depression measures standardized on healthy children. In a hospitalized sample of children ages 4 to 12 years old, parent ratings of child distress were compared to nurse ratings and children's responses to a pictorial measure. An assessment battery was administered to 70 mothers and children; 32 nurse ratings were also obtained. Results indicated overlap between information obtained from measures of depression and pediatric-specific measures of distress. However, the findings provide some evidence that measures that incorporate the pediatric context in assessment may be more suitable for medically ill children. Children's reactions to medical intervention vary considerably, but emotional distress during hospitalization is typical. In a pediatric context, emotional distress may be manifest as affective symptoms of depression (e.g., dysphoria, irritability) and behavioral signs of distress (e.g., social withdrawal, agitation, anxiety). Such distress can interfere with medical procedures, and research has historically demonstrated that without intervention during their stay, children display more long-term emotional and behavioral problems following hospitalization (e.g., Douglas, 1975;Melamed & Siegel, 1975).A review of studies utilizing diagnostic criteria indicated that as many as 40% of children in pediatric settings exhibit depressive symptoms ). An early study of 7-to 12-year-old children found that 38% exhibited dysphoric mood during hospitalization, based on semistructured interviews of the parent and child (Kashani, Barbero, & Bolander, 1981). An examination of referral questions provided to a pediatric psychology service on inpatient children in a children's hospital found that 19% of consultations were referred for depression or suicide attempts, and 12% of consultations were referred for adjustment to chronic illness (Olson et al., 1988). A review of the effects of hospitalization and surgery on children estimated that at least 20% of children experience emotional as well as behavioral difficulties (Yap, 1988). Focusing on behavioral manifestations of distress, parent ratings of child behavioral upset during hospitalization have been found to be significantly higher than ratings of child distress at home (Rodriguez & Boggs, 1994). Younger pediatric patients also appear even more likely to display emotional distress than older children (Jay, Ozolins, Elliott, & Caldwell, 1983;Saylor et al., 1987;Yap, 1988). The variable findings regarding the prevalence of emotional distress in medically ill children may be attributable to variability in the definition and presentation of emotional distress, or to differences in assessment or in the incidence of distress associated with distinct medical groups (Kashani & Breedlove, 1994).Obstacles in assessment complicate the study of emotional distress in pediatric samples. Few measures appropriate for use with hospitalized children...