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Perceived control as a predictor of distress in children undergoing invasive medical procedures
1Behavioral Medicine Unit, University of Rochester Cancer Center, New York 14642.
Insights
Children experiencing uncertainty about the source of control during medical procedures report higher anxiety. Understanding perceived control is key to reducing distress in pediatric patients.
Area of Science:
- Pediatric Psychology
- Medical Sociology
- Developmental Psychology
Background:
- Children's distress during medical procedures is a significant concern.
- Attributional assessment of perceived control is crucial for understanding pediatric anxiety.
- Learned helplessness theory provides a framework for analyzing perceived control.
Purpose of the Study:
- To investigate the role of anticipatory attributional assessment of perceived control in children's procedural distress.
- To examine the relationship between different types of perceived control (Mutual, Powerful Other, Personal, Unknown) and anxiety.
- To determine if children's attributional analysis of unknown perceived control predicts heightened distress.
Main Methods:
- A conceptual model based on learned helplessness theory guided the research.
- 73 children aged 4-18 undergoing blood draws were studied.
- Children's anticipatory attributional assessments and procedural distress (cognitive and behavioral) were measured.
Main Results:
- Children attributing control to an unknown source experienced significantly higher anxiety.
- Unknown perceived control was associated with a 41% interference/extension rate of medical procedures, compared to 13% for known control.
- Self, parent, and observer ratings indicated significantly greater distress in children with unknown perceived control.
Conclusions:
- Anticipatory attributional assessment of unknown perceived control is linked to increased distress in children during medical procedures.
- Investigating attributional variables is important for understanding and mitigating procedure-related distress in pediatric populations.
- Findings support the need for further theory-driven research on perceived control and pediatric anxiety.
Abstract:
Children's anticipatory attributional assessment of the source(s) of perceived control is hypothesized to play an important role in the etiology of distress in children undergoing invasive medical procedures. Four perceived control types, based on learned helplessness theory, are specified by a conceptual model that guides this research: Mutual, Powerful Other, Personal, and Unknown. Among 73 children between the ages of 4 and 18 having their blood drawn, it was predicted that children with an attributional analysis of unknown perceived source of control prior to the impending medical procedures would experience a heightened level of anxiety (procedure-related distress). As predicted, children with an anticipatory attributional assessment of unknown perceived control interfered with or extended the medical procedure significantly more (41%) than children who could attribute some perceived source of control (13%). They were also rated by themselves, the parents, and a trained clinical observer as manifesting significantly greater (p < .05) anticipatory procedural distress using both cognitive (subjective) and behavioral (objective) assessment perspectives. These findings were independent of children's age. This paper supports the need for additional theory-driven research and the importance of investigating the role of attributional variables in the etiology of procedure-related distress in children.