442 Child Health Psychology
The work of Bleil, Ramesh, Miller, and Wood (2000) re-
”ects research in pediatric psychology that builds on these in-
terrelationships. They reported on a cross-sectional study of
children with asthma in which two competing hypotheses
were tested; one hypothesis asserted that quality of the parent-
child relationship would moderate the association of illness-
related functional status with child depression, and the other
hypothesis stated that parent-child relatedness would mediate
the functional status and depression association. Using ques-
tionnaire data from 55 children and their caregivers, Bleil
et al. found support for the mediator model with mothers sug-
gesting that functional status does not directly in”uence
depression in children with asthma nor does the mother-child
relationship buffer or exacerbate the in”uence of functional
status. Instead, it seems that functional status impacts the
mother-child relationship in ways that in”uence the develop-
ment of depressive symptoms. There were no signi“cant
results involving the father-child relationship. These data are
of substantive value because they suggest speci“c targets for
intervention (parent-child relationships) when working to
improve children•s well-being.
The importance of examining adaptation through prospec-
tive studies has been recognized. Kupst and colleagues•
(1995) examination of the adaptation of children diagnosed
with cancer and their families stands out as one of the “rst and
longest prospective studies following families up to 10 years
postdiagnosis. Their work showed the importance of parental
coping in adaptation. Our own work with childhood cancer
(Kazak & Barakat, 1997) supports the association of parent-
ing stress and children•s quality of life during treatment with
well-being of children and their parents posttreatment. Clay
and associates used growth modeling statistical procedures to
examine data from a prospective study of adaptation in 16
children with juvenile rheumatoid arthritis (JRA), 40 children
with IDDM, and 56 healthy children (Clay, Wood, Frank,
Hagglund, & Johnson, 1995). These statistical procedures al-
lowed for analysis of adaptation from a developmental per-
spective and for comparison of three models of adjustment.
They found substantial individual variation in adaptation over
time with parental adjustment and family functioning linked
to changes in adaptation. Findings from these studies point to
the importance of interventions aimed at parent-child related-
ness in addressing psychological functioning. They also
demonstrate the rationale for the increased focus in pediatric
psychology research on testing interventions based on this
broad and solid foundation of descriptive research.
Assumption 4
Outcome studies are important in establishing psychological
interventions within child health. A large body of descriptive
and explicative research has illustrated an increased risk of
child and family adjustment dif“culties in childhood chronic
illnesses. These studies also describe the inherent compe-
tence of children and families and further suggest that inter-
vention is likely to be helpful in mitigating distress and
promoting adjustment. Pediatric psychologists are eager to
apply interventions with established effectiveness to prob-
lems that children and families face around health and
illness-related issues. Changes in health care and increased
demands for showing the effectiveness of treatments have ac-
celerated efforts to communicate more widely about effective
treatments. Surprisingly few treatments have been investi-
gated in a scienti“cally rigorous manner. However, many
child health interventions help children and families. Similar
to debates within clinical psychology, more broadly, the ways
in which treatments are evaluated, promoted, and potentially
translated into practice guidelines are viewed with a mixture
of welcome and caution. As a “rst step in evaluating these
interventions, the criteria for •empirically supported treat-
mentsŽ in psychology have been applied to pediatric psy-
chology through a series of review papers in the Journal of
Pediatric Psychology(1999, 2000, 2001).
The basic standards used to establish empirically sup-
ported treatments in clinical psychology, developed by a
taskforce within Division 12 (Clinical Psychology) of the
American Psychological Association, guided the identi“ca-
tion of effective treatments in pediatric psychology (see
Chambless & Hollon, 1998). Following the Division 12
guidelines, a well-established treatmentmust have been eval-
uated in •at least two good between group design experi-
mentsŽ that showed that the treatment was superior to a
placebo or alternate treatment or equivalent to an already es-
tablished treatment in studies with adequate statistical power
(sample size of 30 per group). A series of nine or more well-
designed case studies, in which the treatment is contrasted
with another treatment, is also acceptable. Treatment manu-
als and a complete description of the sample were also re-
quired. Finally, to be deemed well-established, the “ndings
must have been reported by two different laboratories. A
probably efficacious treatmentrequires two experiments that
show that the treatment was more effective than a waitlist
control group or one or more experiments meeting the well-
established criteria, but without replication by independent
research teams.
The movement to establish criteria for effective treatments
is critical to demonstrate that psychological interventions are
powerful and meet relatively rigorous scienti“c scrutiny of
their merit. Nonetheless, setting standards for effective treat-
ments has generated discussion of the short- and long-term
implications of categorizing treatment approaches by effec-
tiveness, particularly in areas in which intervention research