Access Type

Open Access Dissertation

Date of Award

January 2017

Degree Type


Degree Name




First Advisor

Christopher J. Trentacosta


Substantial gains in the survival rate of children diagnosed with cancer have been achieved; however, a large body of evidence exists that children and their families are at increased psychosocial risk. Missing from our understanding is how real-time, moment-to-moment interactions build to long-term, developmental changes in child functioning. This project expands our understanding of the variation in child distress during procedures as well as long-term adjustment. Real-time coding and global ratings of parent and child behaviors were used to describe parent-child interactions in terms of dyadic flexibility and dyadic mutuality.

To carry out this project, a new system of collecting data needed to be created or an existing system needed to be adapted. Based on previously published examples and pilot testing, two systems were selected for adaptation for the current project. The SPAFF is a real-time coding system that uses a holistic approach of integrating verbal statements, non-verbal behaviors, and tone of voice to create an overall label of emotional state (Coan & Gottman, 2007; Lunkenheimer et al., 2011). This system was used to examine emotional flexibility in a parent-child dyad during a hospital visit for a port start procedure that was part of the child’s cancer treatment regimen. Dyadic mutuality was adapted from the PARCHISY (Deater-Deckard et al., 1997) which uses global ratings of parents and children. The specific aims of this study were Aim 1: evaluate the implementation of the coding and rating system in a hospital setting, Aim 2: examine the association between child temperament and the observations of the parent-child dyad in the hospital room, Aim 3: investigate the association between parent-child hospital room behaviors and child distress & cooperation during the procedure, and Aim 4: assess the predictive ability of parent-child hospital room behaviors on long-term child internalizing and externalizing problems.

The overall findings of this study support a model in which child ego-resilience is associated with parent-child hospital room behaviors. Parent-child hospital room flexibility and mutuality are associated with long-term child externalizing problems. These findings are consistent with previous work from the same research sample as well as the general child development literature.