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Hintergrund
Adipositas ist im Kindes- und Jugendalter stark verbreitet. Medizinische Rehabilitationsmaßnahmen mit ihrem umfassenden Behandlungsangebot stellen eine wesentliche Säule der Versorgung dar. Da Adipositas mit vielfältigen psychosozialen Belastungen verbunden ist, stellt sich die Frage, ob psychotherapeutische Angebote noch stärker berücksichtigt werden sollten.
Fragestellung
Untersucht wurde, wie verbreitet psychische Auffälligkeiten bei Kindern und Jugendlichen mit Adipositas sind und in welchem Zusammenhang sie zum Gewichtsverlauf stehen.
Material und Methoden
Die Stichprobe bestand aus 220 Kindern und Jugendlichen mit Adipositas (8 bis 16 Jahre, M = 13,11 Jahre; SD ± 1,88 Jahre; 54,5 % weiblich), die an einer stationären Rehabilitationsmaßnahme teilnahmen. Emotionale- und Verhaltensauffälligkeiten (Strengths and Difficulties Questionnaire, SDQ) wurden zu Rehabilitationsbeginn sowie 6 und 12 Monate nach Rehabilitationsende im Elternbericht erfasst. Zudem wurden Daten zur Bestimmung des Gewichtstatus durch das medizinische Personal der Kliniken bzw. in der Katamnese von Hausärzten erhoben.
Ergebnisse
Fast die Hälfte der Kinder und Jugendlichen (48,6 %) wies auffällige Werte auf; v. a. Mädchen waren signifikant häufiger betroffen. Die deskriptive Betrachtung nach Rehabilitationsende zeigte einen vergleichbar hohen Anteil. Zudem wirkte sich das Vorliegen psychosozialer Auffälligkeiten signifikant negativ auf den Gewichtsverlauf aus.
Schlussfolgerung
Psychische Probleme sollten im Rahmen der Adipositastherapie stärker berücksichtigt werden. Zum einen sollten evtl. belastete Kinder durch Screenings identifiziert werden, zum anderen psychotherapeutische Maßnahmen zur Reduktion psychosozialer Belastungen integraler Bestandteil der Behandlung sein.
Background: Chronic abdominal pain (CAP) in childhood is a commonly occurring condition and shows a high stability. Psychosocial dysfunctioning of children, such as increased stress experience, is a burden for children and parents and complicates clinical management. Additional comorbid disorders may develop. To minimize the onset of such disorders, treatment at an early stage and taking psychosocial aspects into consideration is strongly recommended. Through this approach, the cognitive-behavioral, child-centered group program 'Stop the pain with Happy-Pingu' was developed, applied, and subsequently evaluated. What is the psychosocial situation of the affected children? Can the cognitive-behavioral group program be applied to improve psychosocial limitations? Method: The cognitive-behavioral group program comprises 6 weekly sessions for children and 1 single meeting for parents. In a randomized controlled study, the program was evaluated with 29 children aged between 6 and 12 years. The evaluation was based on a comparison between the intervention group (IG) and the waiting list control group (WLC), measured at 3 measurement points: T1 (pre), T2 (post), and T3 (3-month follow-up). Results: Emotional problems in particular can emerge in children with CAP. The program was well received, with a high level of participation through to completion. The results demonstrate that children participating in the IG experience significant stress reduction and improved psychosocial functioning compared to children participating in the WLC. The effect sizes range from medium to high. Conclusions: Drawing upon the above findings, multimodal cognitive-behavioral techniques appear to be suitable to successfully treat children with CAP. However, further controlled studies are required to identify the specific elements of the training that are most effective in reducing pain.
Body dissatisfaction and an unrealistic perception of own body size are particularly common in obese children and adolescents; however, little is known about the association with weight-related quality of life and the impact on successful long-term weight loss.
At the beginning of an inpatient child obesity rehabilitation program, 408 children and adolescents aged 9-12 years completed a questionnaire on body image (body silhouettes) and a body weight-specific questionnaire for overweight and obese children and adolescents (GW-LQ-KJ) on quality of life. Height and weight were measured by a physician at the beginning and 1 year after inpatient hospitalization.
Of the participants 91.9 % reported body dissatisfaction and 75.7 % underestimated their own body size. There were no gender-specific differences in body dissatisfaction but boys perceived their body size more realistically than girls. Participants with body dissatisfaction and realistic body size perception showed a reduced weight-related quality of life. Those participants who realistically perceived their body size also lost less weight in the long term.
The subjective underestimation of body size proved to be important for reduced weight-related quality of life and more pronounced long-term weight loss; therefore, body image should be taken into account in multimodal treatment programs.
Past research indicates an association in adults and young people of emotional and contextual factors with a higher risk for the development of eating disorders or obesity. Few studies focus on problematic eating patterns in childhood, especially in association with parental feeding strategies. 482 mothers completed a questionnaire about eating behaviors and the weight status of their 1- to 10-year-old child as well as their own feeding strategies. A classification of the child's eating behavior (food responsiveness, emotional eating, external eating, eating time and meal structure) using hierarchical cluster analysis revealed a conspicuous eating pattern (10 %) showing above-average values in all eating behaviors. Controlling for weight and demographic variables mothers of children with conspicuous eating patterns were characterized by restrictive strategies and were less likely to encourage or facilitate their child to control his or her eating. Similar problematic eating patterns were also identified in early childhood. The association of maternal feeding strategies - beyond weight control issues - with conspicuous eating patterns in children might indicate a possibility of early prevention through parent training.
The preference for fruits and vegetables is the main predictor for the longtime healthy eating behavior. There are many factors which affect the development of food preferences. The familiarity with different foods seems to be a special aspect associated with the corresponding preference. To establish a preference for fruits and vegetables during early childhood, we need to know more about the factors that affect this preference development. So far, research has mostly concentrated on the food intake and less on the corresponding preference. Additionally, it is often based on studies of the mere-exposure effect or on older children and their ability to label fruits and vegetables correctly. Findings about the level of food familiarity in young children and its relation to the actual food preference are still missing. Our study focuses on different aspects of food familiarity as well as on their relationship to the child's preference and presents results from 213 children aged 2 to 10 years. Using standardized photos, the food preference was measured with a computer-based method that ran automatically without influence from parents or interviewer. The children knew fewer of the presented vegetables (66 %) than fruits or sweets (78 % each). About the same number of vegetables (63 %) had already been tasted by the children and were considered tasty. Only 48 % of the presented vegetables were named correctly - an ability that increases in older children. Concerning the relationship between the familiarity with vegetables and their preference, the different familiarity aspects showed that vegetables of lower preference were less often recognized, tasted, considered tasty, or named correctly.
Vorgestellt wird ein Instrument zur Erhebung muetterlicher Steuerungsstrategien in der Essenssituation (ISS), fuer deren Erfassung bislang kein deutschsprachiges, ueberprueftes Instrument vorliegt. Dazu wurde an 163 Muettern mit Vorschulkindern ein auf Grundlage bereits existierender englischsprachiger Instrumente (CFQ, CFSQ) sowie Fokusinterviews mit Experten und Muettern entstandener Itempool ueberprueft. Die Studie berichtet ueber die faktoren- und itemanalytischen Ergebnisse, nach denen sich 21 Items als trennscharf und verstaendlich erwiesen. Eine explorative Faktorenanalyse ergab sechs Faktoren, die zusammen 68% der Varianz aufklaerten. Sie umfassen aktive Strategien, wie Restriktion, Draengen und Belohnung, aber auch passive Steuerung durch Vorbild, Monitoring und die Staerkung der Eigenverantwortung des Kindes. Analysen zu Unterschieden im Steuerungsverhalten der Mutter bestaetigten die Faehigkeit des Instrumentes zur Differenzierung zwischen Muettern mit verschiedenem soziooekonomischen Status und Kindern unterschiedlichen Gewichts.
The aim of this study was the development and psychometric assessment of a questionnaire for functions of OCD (FFZ). The instrument was analyzed using factor and item analyses with a sample of 120 OCD patients within the first 5 weeks of an inpatient cognitive-behavioral treatment. The revealed scales were OCD as self-confirmation, emotion regulation, avoidance of responsibility, interpersonal regulation and OCD as occupation. The reliabilities of all subscales and the total value were satisfactory to nearly excellent. The factorial validity was good, content validity was excellent. The FFZ shows correlations with measures of interpersonal problems and emotional competence, but none with measures of self-reflection and therapy experience. No differences were found for gender or age. The results provide initial support for the reliability and validity of the FFZ.