Pediatric Psychology Midterm

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Developmental approach to pediatric health psych.

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Maddux, Roberts, Sledden, & Wright (1986)

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developmental approach is future oriented and concerns problems particular to developmental periods--affected by motor, cognitive, and psychosocial development

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Maddux, Roberts, Sledden, & Wright (1986)

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Disease model—diagnosis and related treatment

- Neuromaturational model—predominant role of genetics in health

- Transactional model—biopsychosocial, focus on family interaction

- Life course health development model —early experiences (risk and protective factors) affect later health- i.e. micropathways

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Halfon, Russ, & Regalado (2005)

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As technology and knowledge improves, pediatrician's role changes

- Shift from managing acute illness to managing chronic disease

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Halfon, Russ, & Regalado (2005)

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Describe health in positive terms

Health- able to develop and realize potential, satisfy needs, interact successfully with biological, physical, & social environments—Nat. Research Council & IOM

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Halfon, Russ, & Regalado (2005)

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Collaborative team functioning

o Shared responsibility in patient care, clearly delineated roles, all have contact with family, often thru regular meetings

o Emphasis on team decision making and shared decision making with families

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Drotar (1995)

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Physicians may encounter resistance when suggesting a complaint is psychological

o Solution is collaborative management that includes psychological services from the beginning, reduces stigma

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Drotar (1995)

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Family-centered care

o Families involved at all levels of care- individual, program and policy

o Collaboration, mutual respect, focus on family strengths, developmental needs, supporting families financially and emotionally

o May require professionals and families to learn new skills

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Wallace, et al. (1997)

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Family roles

o Experts in the care of their children

- Professionals should provide frequent and accurate info about condition

o Coordinate multiple service providers

o Consultants- i.e. serve on committees and task forces

o Teach professionals

o Provide support thru family networks

o Advocates

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Wallace, et al. (1997)

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When considering developmental outcomes of children in families affected by HIV/AIDS, many factors must be considered such as poverty, drug use, and a violent, racist context ---interventions should have features that address each level

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Blackwell, Gruber, & vonAlmen (1997)

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Lengthened life-span for those infected due to prophylactic and antiretroviral drugs

- Therefore, shift from acute to management of a chronic illness

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Blackwell, Gruber, & vonAlmen (1997)

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Effects of HIV on development

o Language and cognitive impairment, emotional and behavior problem

o Immune functioning related to ability

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Blackwell, Gruber, & vonAlmen (1997)

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PAP- Pediatric AIDS Program

o Case management, education & outreach, mental health counseling, substance abuse counseling, respite care

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Blackwell, Gruber, & vonAlmen (1997)

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o Case management - identify family needs, develop goals, create Individualized Family Service Plan, help family to obtain and coordinate services, help families to advocate for themselves

o Support services - transportation, child care, mental health services, support groups, distribution of food, baby items, parenting

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Blackwell, Gruber, & vonAlmen (1997)

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• focuses on discussion of the CHIP program: Child Health Insurance Program, which is a federal grant program that gives states the options to receive federal $ to target insuring low-income children whose parents earn just enough to be ineligible for Medicare and do not receive health insurance from their jobs
• Weaknesses of the CHIP program: lack of uniformity of requirements from state to state; difficult and confusing application process for those who qualify; many who qualify don't know about it
• goal of the program is to have all children in the U.S. insured

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Kronenfeld & Mathieson (2003)

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• the increased survival of children with acute illnesses early in life has resulted in a greater number of individuals with social-emotional, physical, and learning issues that impact overall well-being

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Ireys & Katz in Wallace (1997)

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• 2-32% of U.S. children have disabilities or chronic illness
• the most common chronic illnesses are asthma and other chronic respiratory or allergic conditions

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Ireys & Katz in Wallace (1997)

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• there has been an emergence of special populations of children with chronic illnesses and unique profiles, i.e., children w/ HIV, children who were born with low birth weight, children who suffer from FAS

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Ireys & Katz in Wallace (1997)

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• describes new morbidity as "chronic, complex, handicapping conditions of multiple organs," many of which have long-term psycho-social effects on the individuals and the families

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Landrigan (1997)

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• though there's a decrease in the number of infectious diseases, children now are more susceptible to problems from environmental toxins--a major part of the new morbidity

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Landrigan (1997)

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• Lists 3 major diseases that are part of the New Morbidity: Environmental Disease, Childhood Cancer, and Endocrine Disruptors

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Landrigan (1997)

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• Environmental Diseases: a) Lead Toxicity--associated with lower verbal IQ, reading difficulties, lower graduation rates, violent criminal behavior, drug use; and b) Air pollution--asthma and allergies

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Landrigan (1997)

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• Childhood Cancer--leukemia used to be terminal, now 75-80% of children survive; sited research that found that environmental factors cause a vast majority of human cancer, with only 10-20% caused by genetic factors; many children were exposed to most of the carcinogens they're exposed to throughout their entire life prior to age 5

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Landrigan (1997)

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• Endocrine Disruptors--some products and pollutants in the environment have been shown to disrupt hormone function in the body

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Landrigan (1997)

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Pediatrics is no longer focused on infectious disease rather on psychosocial issues (psychological, mental, challenges presented by SES, family structure changes due to increase in divorce, and challenges around health care access

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American Academy of Pediatrics (2001)

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• They listed a number of ways for the field of pediatrics to respond to this shift in pediatric care:
o expanding pediatric training programs to include training in children's developmental, psychological, and behavioral needs
o updating the Diagnostic and Statistical Manual for Primary Care Child and Adolescent Version, which aids in early identification of illnesses
o improving pediatricians interviewing and counseling skills for screening and diagnostic purposes
o collaboration between pediatricians, psychologists, and psychiatrists to meet the mental and physical needs of patients; and specifically collaboration with the psychiatrist will allow for gaining information about the new lines of psychtropic drugs that are available for children and adolescents for things like bipolar, depression, or ADHD

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American Academy of Pediatrics (2001)

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• infectious diseases allow for a decrease in infant and young childhood fatalities (the old morbidity), but now is being replaced by chronic illnesses and conditions (i.e., asthma and obesity) with 1 in 10 children being diagnosed with mental health problems

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Stein, Stranton, & Starfield (2005)

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• new definition of health-different domains (mental, physical, sociological, financial, emotional, cultural) interact dynamically to affect children's health over time

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Stein, Stranton, & Starfield (2005)

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• increased number of children failing and dropping out of school increases the number of adults who have low-paying jobs and SES stressors

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Stein, Stranton, & Starfield (2005)

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The magic of touch

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Colt (1997)

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-Touch is a “primal need” of humans
-Idea that touch can heal, dates back to ancient times (science is just now confirming this)
-Research has shown massage to have positive effects on many conditions (stress, hyperactivity, diabetes, anorexia, asthma, boosts immune functioning etc.)

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Colt (1997)

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-Simple touch can reduce heart rate, lower blood pressure, and stimulate brain to produce endorphins that naturally suppress pain
-Studies show that preemies that were regularly massaged were discharged from hospitals 6 days sooner, saving billions of dollars annually

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Colt (1997)

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Although it would save $, only very few hospitals have invested in massage programs
-This may be due to the fact that America is considered a “nontactile” society compared to other cultures (we are less tolerant of touch and may therefore depriving our children of something that has proven necessary and beneficial in the process of development)

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Colt (1997)

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-Future research shouldn’t focus on Nature vs. Nurture, but the interplay between the two and how they work together to affect stress, coping, & resilience

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Rutter (1994)

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-Instead of looking at traumatic events in isolation, we must focus of the series of events leading up to the tramatic occurrence as well as the events that results from and follow it. “It is the aggregated accumulation of events over time that contributes to the emergence of psychological resilience or vulnerability in individual cases.”

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Rutter (1994)

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Animal research has shown that early experiences “program” the brain in ways that affect later cognitive functioning, emotional responding etc.

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Gunnar & Barr (1998)

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-Glucocorticoids-help to mobilize & distribute energy stores, influence immune system activity, and coordinate adaptive behaviors
-Glucocorticoids type II receptor most tied to regulating stress & most affected by early experiences

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Gunnar & Barr (1998)

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-Stress leads to increased levels of cortisol. Prolonged exposure to cortisol affects brain development in areas of memeory, neg. emotions, and attention regulation

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Gunnar & Barr (1998)

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-Sensitive, responsive caregivers & secure emotional relationships in childhood serve as protective factors against later stress reactivity

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Gunnar & Barr (1998)

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-Child health problems higher for poor and single mother-headed households

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Graham-Berman & Seng (2005)

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-Although studies have shown that kids exposed to violence have higher rates of anxiety, fears, aggression etc., studies of the physical health of kids exposed to violence is rare

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Graham-Berman & Seng (2005)

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-Study results showed the strongest predictors of poor child health were the mother’s own health and the child’s level of traumatic stress
-Practical implications-calls for clinical interventions to increase mothers’ safety and to enable them to keep their kids safe may improve child health

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Graham-Berman & Seng (2005)

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-Pediatric Psychologists need not only to focus on the maltreatment of children, but on how exposure to family and community violence can have significant impact of children’s physical health

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Graham-Berman & Seng (2005)

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-the developmental course of illness is influenced by physical,
psychological, and social factors.

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Beale (2006)

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-research has aimed to identify psychological interventions that
effective in improving, both, psychological and physical states
associated with illness.
- the problem in doing this is that different studies of a certain type
of intervention differ in the specifics of the intervention used,
implementation, research design, etc.

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Beale (2006)

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-meta-analysis allows the combining and comparing of results of
studies, it allows conclusions that are more accurate than those taken
from single studies or from qualitative narrative reviews.

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Beale (2006)

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methodological quality of studies, also criticize for combining results
of studies that vary importantly in aspects of procedure and
measurement.

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Beale (2006)

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-main finding - few intervention studies meeting validity criteria were
located for most of the illness types.
-the findings support the view that psychological interventions can be
effective when used in conjunction with other treatments of illnesses.

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Beale (2006)

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Minor illness necessary for the development of social competence and healthy personality—capacity for coping

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Parmalee (1997)

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“illness” incorporates the psychological, while “disease” is biological

- Illness is a social concern- change in mood states, low energy, inability to complete work

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Parmalee (1997)

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- When children are ill- need support of family- parents model empathy, expressing emotions, and prosocial behavior
- Once they have an illness, they then learn to inquire after others’, show sympathy and care for family members’ sickness

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Parmalee (1997)

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- When children are ill they may receive special treatment from parents and be held less accountable for behavior, chores, and extra demands

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Parmalee (1997)

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- Opportunities to practice this at all developmental periods with frequent minor illness
- Also opportunities to observe parents and siblings cope

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Parmalee (1997)

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- Minor illnesses can be disruptive of family interactions…i.e. parents lose confidence, feel like bad parents
- Parents should try to continue pleasurable social interactions with their children while they are ill

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Parmalee (1997)

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- Moral rules, social convention rules, personal rules, & prudential rules (helpful or harmful, i.e. risk taking behavior)

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Parmalee (1997)

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- Research study to assess parental beliefs regarding developmental benefits of childhood injuries

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Lewis, DiLillo, & Peterson (2004)

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o Belief that enduring hardship may promote development of improved physical or emotional strength or resilience to future harm
o Physical and social stressors may have benefits such as increased stress tolerance, physical endurance, and reduced susceptibility to disease

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Lewis, DiLillo, & Peterson (2004)

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o Parents belief minor injuries can teach children a lesson to be more careful, and also may be character-building, teach pain-tolerance, and improved coping
o Fathers may more strongly endorse these notions, particularly bc they engage in physical activity with children

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Lewis, DiLillo, & Peterson (2004)

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o Fathers encourage boys to be active, and encourage girls to be less risky
o Greater acceptance of physical risk taking for boys, clumsiness for girls
o Beliefs may affect how opportunities for injury risk are structured

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Lewis, DiLillo, & Peterson (2004)

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- Results
o 73% of parents surveyed believe that children learn from their injury experiences
o Parents did not strongly endorse the idea that injuries strengthen or toughen children up
o Fathers were more likely to believe in toughening
o No child gender effect for preschoolers, maybe for older children

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Lewis, DiLillo, & Peterson (2004)

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• Many times younger children view illness as a form of punishment and may experience self-blame and guilt

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Perrin & Gerrity (1981)

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• 10-12 yr-olds begin seeing illness as a complex, multifaceted process and interaction between the body factors and the infectious agents' factors

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Perrin & Gerrity (1981)

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• Found in study that across all ages, illness prevention was the one subject that children of all ages had difficulties fully understanding
• Children's increased understanding of illness slightly lags behind their overall cognitive development

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Perrin & Gerrity (1981)

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o Preoperational Children (K & 2nd graders):illness defined by external signals of the illness (i.e., when told by adults they are sick, they have to stay in bed) or by being disobedient to a rigid set of health rules (i.e., going outside without a coat on); getting better happens magically on its own or by obeying the rules, like eating chicken soup or staying in bed

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Perrin & Gerrity (1981)

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o Concrete Operational Children (4th & 6th graders): illness is defined as a set of multiple concrete symptoms caused mostly by germs; avoid illness by staying away from sick people to keep away from germs; get better by heeding the advice given by adults (i.e., taking care of self) and letting medicine work on the illness--doesn't recognize body's role in healing itself

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Perrin & Gerrity (1981)

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o Formal Operational Children (8th graders): illness has numerous causes (different infectious illnesses) which the body may respond to in a variety of ways; see that illness is complex interaction between the host and agent factors; recognize that the body must fight the illness

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Perrin & Gerrity (1981)

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• discussed past research findings stating that young children tend to attribute illness and treatment as punishment for violating a set of rules and pointed to two reasons explaining this phenomenon-children may have:
 phenomenistic thinking-failure to recognize necessity of a causal mechanism between causes and effects
 imminent justice thinking-belief that Nature can seek retribution for misdeeds

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Kato, Lyon, & Rasco (1998)

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• Kato et. al, hypothesized that children in these past studies may be shown to be deficient in their understanding of illness b/c they lack the verbal skills to communicate their knowledge to researchers, who ask open-ended questions
• cited other studies where children were seen to RECOGNIZE correct causes of illness when presented with alternatives

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Kato, Lyon, & Rasco (1998)

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• Found that when verbal demands are decreased, children as young as 3 yrs. old were able to distinguish between illness concepts (sickness & treatment) from moral concepts (naughtiness and punishment)--suggesting children don't see their illness as caused by their own wrongdoing
• Children who had chronic illnesses had slightly more difficulties differentiating between illness and treatment and punishment

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Kato, Lyon, & Rasco (1998)

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• Overall indicates that different methods of gathering data from children (i.e., open-ended, structured clinical interviews vs. tasks w/lower verbal demands) can impact the type of information obtained from children

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Kato, Lyon, & Rasco (1998)

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- A developmental biopsychosocial approach to the treatment of chronic illness in children and adolescents

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Wood (1995)

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- Goals of intervention
o Minimize the impact of the disease on physical and emotional development and functioning of child and family
o Achieve a balance between disease management and quality of life
o Facilitate integrated functioning of the chronically ill child with psychosocial surroundings

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Wood (1995)

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- Bidirectional influence indicates need for multilevel treatment
o Chronic illnesses affect psychosocial development of children and their families
o Stressful psychosocial factors have negative consequences for health by directly influencing the disease process and interfering with disease management
o Continuum of psychosocially (behavioral) and physically manifested disease

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Wood (1995)

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- Issues, examples of continuum balance
o Chronic illness can impede psychosocial well-being and development
o Emotional and financial stress
o Necessity for family structure to change to accommodate demands of illness
o Maladaptive family patterns to interfere with disease management- i.e. poor coordination of medical care or direct influence
o Chronic illness to disrupt school and peer functioning

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Wood (1995)

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- Well-being of patient depends on dynamic balance of individual physical functioning, individual psychological functioning, & family-social functioning

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Wood (1995)

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4 models of infection
1. associational- preschool
proximity, primitive relationship
2. physical- transfer/contact but w/o concept of germs
3. biological- adult concept of germs
4. differentiated biological- diseases caused by specific germs
4

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Kalish (1999)