Adult command structure and children's distress during the anticipatory phase of invasive cancer procedures

In this study, we examined the ways in which adults issued commands to children (adult command structure) and children's distress during invasive cancer procedures. Forty-five children with cancer, ages 5-15 years, were videotaped during an intramuscular injection (IM) and a lumbar puncture (LP). Child distress was coded via the Observation Scale of Behavioral Distress. Adult commands were classified as specific direct, specific softened, specific phrased as question, or vague in structure. The results indicated that the relative proportion of vague commands was positively related to child distress. This apparent ineffectiveness of vague commands is consistent with the behavior management literature. In contrast, the relative proportions of specific direct commands issued by parents during IMs and specific softened commands issued by nurses during LPs were associated with lower levels of child distress. The findings suggest that clinical interventions as well as developmental models of adult-child interactions may need to be both setting and participant specific.