Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Psychology


Clinical Psychology

Content Description

1 online resource (iii, 66 pages) : illustrations

Dissertation/Thesis Chair

Leslie Halpern

Committee Members

Julia Hormes, Drew Anderson


Blood sugar monitoring, Distraction (Psychology), Children, Diabetes in children, Pain in children

Subject Categories

Clinical Psychology


Research indicates that nonpharmacological interventions are effective at reducing pain and distress during pediatric procedures. Certified child life specialists often perform these interventions. However, child life delivered procedural interventions have not been well studied in outpatient settings. Additionally, while characteristics that influence pediatric distress levels are known, their impact on procedural response in the presence of nonpharmacological interventions is not fully understood. In particular, the contribution of temperamental negative affect (NA) and effortful control (EC) are relatively unstudied in this context. The present study examined procedural response in a sample of 28 diabetic children and adolescents aged 2-18 years undergoing outpatient continuous glucose monitor (CGM) insertion. A child life specialist was present throughout the appointment to provide intervention. Results indicated that anxiety and fear increased across the procedure, while distress levels were highest immediately prior to insertion. Intervention usage by child life appeared to vary based on procedural phase, child age, temperament, and trait anxiety. However, distraction emerged as the most utilized intervention across phases. The relationship between NA, EC, and procedural response was tested directly in this sample. No relationship between NA and response were found. However, EC emerged as a strong predictor of reduced procedural anxiety, fear, and distress. These findings suggest that high levels of EC may help children to better focus on and implement child life interventions, thus improving their efficacy.