This randomized clinical trial employed a 2-group (general child behavior management training vs. distraction for pain management training) design across repeated parent-administered needle procedures. Forty-seven children with a chronic illness requiring recurrent injections were observed at baseline and 2 intervention sessions. Videotaped observations of parent-child interactions were coded for child behavioral distress and parents' use of behavior management strategies. Across groups, many children displayed minimal to no distress at baseline. Among participants with significant distress, neither intervention group displayed consistently decreased procedural distress or increased use of child behavior management strategies.Children with chronic diseases consider repeated, painful procedures the worst part of having an illness, and do not become desensitized simply as a result of repetition of procedures (Weekes & Savedra, 1988). Lumbar puncture (LP) and bone marrow aspiration (BMA) typically have been the most painful procedures, and are now nearly always performed under sedation or general anesthesia (Cohen, Blount, Cohen, Schaen, & Zaff, Correspondence should be addressed to Keith J. Slifer, Behavioral Psychology Department, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205. slifer@kennedykrieger.org. NIH Public Access Author ManuscriptChild Health Care. Author manuscript; available in PMC 2010 August 16. Dahlquist, 1992Dahlquist, , 1999Jay, Elliott, Katz, & Siegel, 1987). Less invasive but frequently repeated procedures, such as venipuncture and subcutaneous (SQ) or intramuscular (IM) injections, have been described as "a major source of distress and apprehension" for children (Jacox, Carr, & Payne, 1994). Similarly, research indicates that a substantial proportion of children display significant levels of distress during pediatric immunization procedures (Jacobson et al., 2001). For example, Jacobson et al. found that at least 20% of children aged 4 to 6 years exhibited levels of distress in the high range of their measures. In addition, results of a national telephone survey (Princeton Survey Research Associates [PSRA], 1996) revealed that needle procedures are the things they dislike most about obtaining health care services.Pediatric procedural distress disrupts necessary medical care, diminishes the child's quality of life, and produces psychosocial stress for families. Chronic distress related to repeated painful procedures may place the child at increased risk for behavioral or psychological disturbances outside of the medical context, negatively impacting home and school adjustment. Severe procedure-related behavioral distress can necessitate increased sedation; physical restraint; and, in some cases, general anesthesia. These interventions can increase both the risks associated with treatment and the degree to which the treatment disrupts the child's life (e.g., due to increased time spent recovering from medication effects; Anderson, Zelter, & Fanurik, 1993). Likewis...

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When comparing children with and without oral clefts in an experimental setting, with a relatively small sample size, behavior analysis identified some significant differences in patterns of social behavior but not in the ability to express facial emotion. Results suggest that many children with oral clefts may have relatively typical social development. However, for those who do have social competence deficits, systematic behavioral observation of atypical social responses may help individualize social skills interventions.