Chapter 14 Psychological Factors Affecting Medical Conditions TRUE OR FALSE 1. The earlier term Psychosomatic Disorders is an historical predecessor of the DSM-IV category Psychological Factors Affecting Medical Condition. Answer: True 2. Minority and poor children are overrepresented among youth with asthma. Answer: True 3. Psychological stimuli and emotional upset are often considered triggers of asthmatic attacks. Answer: True 4. Research suggests that negative family emotional climate is associated with asthma severity. Answer: True 5. The effects of any chronic illness on a family or the individual are likely to be small and inconsequential. Answer: False 6. Research indicates that there is little variability in adjustment in chronically ill youth. Answer: False 7. A functional limitation of a chronic illness is defined as a restriction the youth experiences as a result of the chronic condition. Answer: True 8. Research by Wagner and colleagues (2003) found that parental distress impacted young people with juvenile rheumatoid arthritis regardless of how they perceived their illness. Answer: False 9. Research on issues of conflict, organization and control in families of youth with diabetes found that low conflict and high organization were associated with better outcomes. Answer: True 10. The research on family cohesion in cancer survivors indicates that the level of cohesion is consistent from diagnosis through years after remission. Answer: False 11. The five-year survival rate for childhood cancer hovers around 40 percent. Answer: False 12. There is evidence that radiation and chemotherapy are associated with later impairment in cognitive and academic functioning. Answer: True 13. Youngsters with HIV are at risk for significant learning, language, and attention difficulties in addition to the impairments associated with the disease; however, improved antiviral therapy has slowed down the progression of the disease. Answer: True 14. Attempts to directly reduce the symptoms of actual physical illnesses through traditional psychotherapy have largely been successful. Answer: False 15. Hyperglycemia is the term used to describe excessively high levels of blood glucose. Answer: True 16. The concept of a "honeymoon period" for diabetes refers to the fact the onset of diabetes often occurs following the stress of a major life event. Answer: False 17. Knowledge about a disease, such as diabetes, is not always associated with compliance with treatment regimens to control the disease. Answer: True 18. Adherence to the diabetes regimen typically increases during adolescence. Answer: False 19. Health care providers have little influence on adherence to medical regimens in the adolescent population. Answer: False 20. The term biofeedback refers to a procedure in which a medical device gives immediate feedback to the person about a particular biological function. Answer: True 21. The three response systems that may be assessed in children’s pain during medical procedures are cognitive-affective, behavioral, and physiological. Answer: True 22. The perception of control during adverse treatment procedures seems to have positive outcomes. Answer: True 23. Emotive imagery is a technique where images are used to increase emotions. Answer: False 24. Research indicates that valium is as effective as cognitive behavioral strategies for pain management. Answer: False 25. Less than 10 percent of people are hospitalized during their youth. Answer: False 26. Presently, approximately 98% percent of hospitals in the U.S. and Canada allow unrestricted parental visitation during childhood hospitalizations. Answer: True 27. Injuries are the leading age of death for youth over the age of 1. Answer: True 28. The currently accepted psychological approach to children who are dying is to protect them from the truth and not burden them with the reality of their death. Answer: False MULTIPLE CHOICE 29. Pediatric psychology A. examines the impact of social and psychological factors on medical conditions. B. is another term for child psychology. C. is practiced only by medical doctors or nurses. D. involves children under the age of 13 (when the patient is older it is considered adolescent medicine). Answer: A 30. In regard to managing asthma, the Loren case study in the textbook highlighted which of the following? A. Separating the child from his/her parent to decrease attacks B. Increasing medication as children age C. Encouraging the parent to take more responsibility D. Teaching the child to control emotions more effectively Answer: D 31. A study by Purcell and his colleagues tested the hypothesis that asthmatic children would become symptom free soon after being sent away from their parents. The results of this study indicated that A. all asthmatic children improved dramatically when they were separated from their parents. B. the children whose symptoms had been classically conditioned improved during separation, whereas the other children did not improve. C. the children for whom emotions were important precipitants improved during the separation, whereas the other children did not improve. D. the children for whom emotions were important precipitants did not improve during the separation, whereas the other children did improve. Answer: C 32. The current view on whether changes in the psychological atmosphere are the basis for improvement in asthmatic symptoms suggests that A. separation from the parents produced changes because the parents were causing the asthma. B. separation may have been successful because the surrogate parents were able to achieve increased compliance with medical regimens. C. changes in the psychological/home environment cannot affect asthma symptoms. D. psychological factors play no role in the understanding of asthma management. Answer: B 33. Research on asthma suggests that A. asthma arises from an excessive, unresolved dependence on the mother and resultant fear of separation. B. psychological factors play an important role in the initial development of hypersensitivity of air passages in asthmatic children. C. psychological factors play an important role in triggering asthmatic attacks. D. genetic factors do not play a role. Answer: C 34. Which of the following is true regarding asthma? A. Asthma arises from excessive unresolved dependence on the mother. B. Asthma is the result of a hypersensitivity of the air passages. C. A “parentectomy” is currently a commonly suggest treatment. D. Family emotional climate has little impact on asthma symptoms. Answer: B 35. More recent research on the role of family functioning in asthma suggests that A. family functioning plays no role in asthma. B. family functioning is a major cause in the initial development of asthma. C. family functioning influences the frequency and severity of asthmatic symptoms. D. parents' management of the child’s asthma is not relevant for young children. Answer: C 36. When one is discussing the impact on adjustment of type of illness, severity, or degree of impairment of functioning associated with illness, one is discussing the role of A. psychosocial stress. B. illness parameters. C. functional impairments. D. adherence. Answer: B 37. Findings regarding the association between chronic illness and children's social/emotional adjustment suggest that A. in general, children with chronic illnesses are better adjusted than a normal control sample. B. the impact of illness severity on adjustment is clear and consistent. C. the young person’s attitude toward the illness may impact the illness. D. there is no association between chronic illness and social/emotional problems in children. Answer: C 38. Research by LeBovidge, Lavigne, & Miller (2005) on arthritis and depression found A. young people with arthritis are more depressed than those with other chronic illnesses. B. there was no difference in depressive symptoms for youth with high versus low stress. C. youth with a positive illness attitude had fewer depressive symptoms than youth with negative illness attitudes. D. negative illness attitudes created more depressive symptoms only when the stress was high. Answer: C 39. Timko and her colleagues' research on risk and resilience factors in the adjustment of youngsters with juvenile rheumatic disease suggests that the A. the adjustment of fathers, but not mothers, was a risk factor. B. the adjustment of mothers, but not fathers, was a risk factor. C. adjustment for both mothers and fathers were risk factors, and social relations for mothers, but not fathers, were protective factors. D. adjustment for both mothers and fathers were risk factors and social relations for both mothers and fathers were protective factors. Answer: D 40. Research by Berg and colleagues on young adolescents with diabetes found A. the child’s relationship with his/her father was unrelated to diabetes outcome. B. monitoring of the illness by the parents was associated with better diabetes outcome. C. monitoring of the illness by the parents led to decreased compliance with treatment regimens. D. parental involvement in managing the illness decreased the teen’s self-efficacy. Answer: B 41. Adjustment to a chronic illness by a youngster and family is A. an issue immediately following the diagnosis. B. of concern during periods of worsening symptoms. C. an ongoing process. D. an issue following relapse. Answer: C 42. Which of the following statements regarding chemotherapy and related treatments for childhood cancer is accurate? A. These treatments have not improved the survival rates for childhood cancer. B. These treatments have immediate, but not long-term, negative side effects. C. These treatments may result in impairment in areas such as attention and learning. D. Impairments from chemotherapy are of particular concern for adolescents. Answer: C 43. Which of the following is accurate with regard to the impact of HIV/AIDS in children and adolescents? A. The number of HIV babies born to HIV-positive women in the U.S. has increased over time. B. HIV is considered terminal and care is focused on keeping the patient comfortable until he/she dies. C. All HIV-infected youth have cognitive, emotional or behavioral problems. D. Youth with HIV have likely been exposed to other high risk factors such as parental loss, parental psychopathology or drug use. Answer: D 44. The term "adherence" describes A. how well a youngster or family follows recommended medical treatments. B. how following religious beliefs helps relieve stress and improves health. C. how a family’s discipline practices affect the health of the youngster. D. how closely individual family members are to each other. Answer: A 45. Which of the following is true regarding diabetes? A. Type I diabetes is the result of the pancreas producing insufficient amounts of insulin. B. Type II diabetes is quite rare in childhood, making up less than 5 percent of new cases in youth. C. Type II diabetes occurs more frequently in Caucasian populations. D. Young people with type II diabetes do not need insulin injections. Answer: A 46. The first task in the treatment of juvenile diabetes is to A. gain control of the diabetic condition. B. reduce the stress related to the illness. C. teach the child how to talk about the illness with friends. D. stop eating sugar. Answer: A 47. Adolescence, compared to earlier development, is a period of problematic adherence to medical regimens because of which of the following? A. Professionals often underestimate the adolescent’s knowledge of the disease. B. Parents often refuse to give up control. C. The adolescent may have low self-efficacy in regard to the ability to manage the illness. D. These teens tend to have few friends so they have no one to help them monitor their illness. Answer: C 48. Research on adherence to diabetes regimens, by Palmer and colleagues, suggests that A. low self-reliance and low pubertal status results in poorer diabetic control. B. low self-reliance and low pubertal status results in greater diabetic control. C. maternal involvement is only influential when the teen is highly self-reliant. D. maternal involvement is more influential when the teen is high in pubertal status. Answer: A 49. Regarding the case study on Cindy, the teen with chronic headaches reported in your textbook, which of the following is true? A. Increasing her medication was crucial to her recovery. B. She was able to produce dramatic changes on physiological responses using biofeedback. C. The cognitive behavioral techniques were not very effective. D. She experienced a complete remission in her pain symptoms. Answer: B 50. Regarding the measurement of pain in young patients, A. it is difficult to differentiate the pain the youngster is suffering from the anxiety the youngster is experiencing while undergoing an aversive medical procedure. B. the physiological component is the aspect of pain that is most frequently assessed. C. the behavioral component is the aspect of pain that is most frequently assessed. D. it is important to assess pain in the same way for youngsters of all ages. Answer: A 51. Which of the following is accurate regarding helping a youngster cope with an aversive medical procedure? A. Reassurance from medical staff is often ineffective. B. Unexpected stress is better than predictable stress. C. Giving the child some sense of control over the procedure is believed to be helpful. D. Parents are often more helpful if they reassure and apologize during the procedure. Answer: C 52. The work of Jay and her colleagues (1987, 1991, 1995) on reducing children's distress during painful medical procedures included which of the following components in the intervention? A. filmed modeling B. negative reinforcement C. parent training D. muscle relaxers Answer: A 53. Preparation of children for hospitalization A. is rarely done in most pediatric hospitals. B. should include having the child observe a model who is apprehensive, but copes with the stresses of hospitalization. C. is likely to involve the child undergoing a medical procedure and then later observing a model who experiences the same procedure. D. might recommend that the child avoid contact with parents and other family members. Answer: B 54. Efforts at preventing childhood injury are impeded by A. the knowledge that serious injuries are very infrequent. B. the perception that most injuries are chance events and therefore unavoidable. C. the absence of behavioral antecedents to injury. D. the impossibility of providing contingencies for injury-related behavior. Answer: B 55. Professionals working in the area of childhood injury have suggested abandoning the term "accident" in favor of "unintentional injury" because A. the term "accident" should be reserved for automobile accidents and similar events. B. "accidents" include purposeful attempts to injure the child. C. "unintentional injury" acknowledges that the event, though not deliberate, might have been avoided. D. "unintentional injury" indicates that there were no behavioral antecedents to the event. Answer: C 56. An understanding of death as final and inevitable, and of personal mortality, emerges at about A. age 5 or 6. B. age 9 or 10. C. age 12 or 13. D. age 15 or 16. Answer: B BRIEF ESSAYS 57. What is asthma? What is a trigger? Explain the difference between a physical and psychological trigger. Give examples. Answer: Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to difficulty in breathing. Symptoms of asthma can include wheezing, shortness of breath, chest tightness, and coughing, especially at night or early in the morning. What is a Trigger? A trigger is anything that causes an asthma flare-up or exacerbation. Triggers can lead to an increase in asthma symptoms or even an asthma attack. Identifying and managing these triggers is crucial for individuals with asthma to maintain control over their condition. Difference Between a Physical and Psychological Trigger Physical Triggers: These are tangible environmental factors or physical conditions that can cause asthma symptoms. Examples include: • Allergens: Pollen, dust mites, mold, pet dander • Irritants: Smoke (tobacco, wood), strong odors (perfumes, cleaning products), air pollution • Respiratory Infections: Colds, flu • Exercise: Particularly intense physical activity, especially in cold air • Weather Conditions: Cold air, sudden temperature changes, high humidity Psychological Triggers: These are emotional or mental factors that can contribute to the onset or worsening of asthma symptoms. Examples include: • Stress: High levels of stress can lead to hyperventilation and increased asthma symptoms • Anxiety: Anxiety can cause rapid breathing and panic, which may exacerbate asthma • Strong Emotions: Laughing, crying, or shouting intensely can lead to an asthma attack Examples Physical Trigger Example: An individual with asthma might experience an asthma attack after spending time in a dusty environment due to dust mites, a common allergen that triggers asthma symptoms. Psychological Trigger Example: An individual with asthma might notice their symptoms worsening during periods of high stress, such as before an important exam or after receiving bad news, due to the body's heightened response to stress and anxiety. Understanding and identifying these triggers can help individuals with asthma manage their condition more effectively by avoiding or mitigating the impact of these triggers in their daily lives. 58. Describe the difficulties in measuring adjustment to a chronic illness. According to the model by Wallander and Varni (1998), what variables need to be considered? (There are seven; list and describe three categories.) Answer: Difficulties in Measuring Adjustment to a Chronic Illness Measuring adjustment to a chronic illness can be challenging due to several factors: 1. Subjectivity: Adjustment is a highly personal experience and can vary significantly from person to person, making it difficult to standardize measurements. 2. Complexity: Adjustment involves multiple dimensions, including emotional, social, and functional aspects, all of which need to be considered and measured. 3. Temporal Variability: Adjustment can change over time as individuals adapt to their illness, experience new symptoms, or encounter different life stages and events. 4. Comorbidities: The presence of other illnesses or psychological conditions can complicate the measurement of adjustment to a specific chronic illness. 5. Cultural Differences: Cultural background can influence how individuals perceive and cope with their illness, adding another layer of complexity to measurement. 6. Measurement Tools: There is a need for reliable and valid tools that can accurately capture the multifaceted nature of adjustment. Wallander and Varni's (1998) Model Wallander and Varni's model identifies seven key variables that need to be considered when measuring adjustment to a chronic illness. These variables are grouped into three categories: 1. Illness-Related Factors: • Severity of the Condition: The intensity and frequency of symptoms and the overall impact on the individual's health. • Visibility of the Condition: How apparent the illness is to others, which can affect social interactions and self-esteem. • Functionality: The extent to which the illness affects the individual's ability to perform daily activities and fulfill roles. 2. Demographic Factors: • Age: Different age groups may have different coping mechanisms and social support systems. • Gender: Men and women may experience and adjust to chronic illness differently due to biological, psychological, and social factors. • Socioeconomic Status (SES): SES can influence access to healthcare, social support, and resources, impacting adjustment. 3. Psychosocial Factors: • Coping Strategies: The methods an individual uses to manage the emotional and practical challenges of their illness, such as problem-solving, seeking social support, or employing avoidance strategies. • Social Support: The availability and quality of support from family, friends, and healthcare providers, which can buffer the negative effects of the illness. • Psychological Well-being: The individual's mental health status, including the presence of depression, anxiety, or other psychological conditions, which can affect their overall adjustment. By considering these variables, researchers and clinicians can gain a comprehensive understanding of how individuals adjust to chronic illness and develop targeted interventions to support their adaptation process. 59. Describe variables that might be investigated if one were interested in the impact of "illness parameters" on the psychological adjustment of youngsters with chronic illnesses. Answer: When investigating the impact of "illness parameters" on the psychological adjustment of youngsters with chronic illnesses, several key variables should be considered. These variables help to understand how different aspects of the illness itself can affect the psychological well-being and adjustment of children and adolescents. Here are the main variables: 1. Severity of the Illness: • Symptom Intensity: The degree to which symptoms are severe and disruptive to daily life. • Frequency of Symptoms: How often symptoms occur, including whether they are constant or intermittent. • Pain Level: The amount of pain associated with the illness, which can significantly affect psychological well-being. 2. Duration of the Illness: • Chronicity: How long the youngster has been living with the illness. Long-term illnesses can have different psychological impacts compared to more recent diagnoses. • Life Stage at Diagnosis: The age at which the illness was diagnosed, as adjustment may differ depending on whether the illness onset was in early childhood, middle childhood, or adolescence. 3. Visibility of the Illness: • External Manifestations: The extent to which the illness has visible symptoms or physical manifestations, which can affect self-esteem and social interactions. • Stigmatization: The degree to which the visible aspects of the illness might lead to social stigma or discrimination. 4. Functionality Impact: • Daily Activities: How the illness affects the youngster’s ability to engage in normal daily activities, including school, sports, and hobbies. • Physical Limitations: Specific physical limitations imposed by the illness, such as mobility issues or the need for special equipment. 5. Treatment Regimen: • Complexity of Treatment: The complexity and intrusiveness of the treatment regimen, including frequency of medical visits, medication schedules, and any required medical procedures. • Side Effects: The presence and severity of side effects from treatments, which can affect both physical comfort and psychological well-being. 6. Prognosis: • Future Outlook: The expected course of the illness, including whether it is stable, progressive, or has potential for improvement or remission. • Uncertainty: The level of uncertainty associated with the illness prognosis, which can contribute to anxiety and stress. 7. Comorbid Conditions: • Additional Medical Issues: The presence of other medical conditions that coexist with the primary illness, which can complicate management and adjustment. • Psychological Comorbidities: The occurrence of psychological conditions such as depression or anxiety, which can interact with the physical illness. By examining these variables, researchers and clinicians can gain a deeper understanding of how specific illness parameters influence the psychological adjustment of youngsters with chronic illnesses. This understanding can inform the development of interventions and support systems tailored to the unique needs of these children and adolescents. 60. In the Lisa case study (the 14-year-old with diabetes) reported in the textbook, what variables were impacting her adjustment to and management of her diabetes? What variables may have motivated her to not manage her illness effectively? Answer: Variables Impacting Lisa's Adjustment and Management of Her Diabetes 1. Illness-Related Factors: • Severity of Diabetes: Complex management regimen (insulin, blood glucose monitoring, diet). • Physical Symptoms: Daily and long-term symptoms affecting life. 2. Psychosocial Factors: • Psychological Well-being: Stress, anxiety, or depression related to diabetes. • Coping Strategies: Methods to handle stress and illness demands. 3. Social Support: • Family Support: Involvement and support from family. • Peer Support: Understanding and support from friends. • Healthcare Support: Relationship with healthcare providers. 4. Developmental Factors: • Adolescence: Desire for independence and peer acceptance. 5. Behavioral Factors: • Adherence to Treatment: Following the diabetes management plan. • Self-Efficacy: Confidence in managing diabetes. Variables Motivating Poor Management 1. Desire for Normalcy: Wanting to fit in with peers. 2. Rebellion and Independence: Typical teenage behavior. 3. Social Pressures: Peer pressure and spontaneous activities. 4. Emotional Response: Frustration, denial, or depression. 5. Lack of Understanding: Not fully grasping the importance of management. 6. Inadequate Support Systems: Feeling overwhelmed without enough support. 7. Negative Experiences: Aversion due to painful or negative diabetes-related experiences. 61. Briefly describe the research on family cohesion and cancer. Answer: Research on family cohesion and cancer has shown that strong family cohesion can significantly impact the psychological and physical well-being of cancer patients. Here are some key findings: 1. Emotional Support: Families with high levels of cohesion provide emotional support, which can help reduce anxiety, depression, and stress in cancer patients. This support fosters a positive outlook and better mental health. 2. Adherence to Treatment: Patients from cohesive families are more likely to adhere to treatment plans and follow medical advice, leading to better health outcomes. Family members often assist in managing appointments, medications, and lifestyle changes. 3. Coping Mechanisms: Strong family bonds help patients develop effective coping mechanisms. Shared experiences and collective problem-solving within the family can alleviate the burden of illness. 4. Quality of Life: Family cohesion improves the overall quality of life for cancer patients. Positive family interactions and support systems enhance emotional well-being and contribute to a sense of security and stability. 5. Communication: Open and effective communication within cohesive families helps in sharing concerns, expressing emotions, and making informed decisions about treatment and care. In summary, research indicates that family cohesion plays a critical role in supporting cancer patients, leading to better psychological adjustment, adherence to treatment, and overall quality of life. 62. What are the potential issues associated with cancer in adolescence? What is it about this particular developmental period that adds to the potential for risk in terms of adjustment? Answer: Potential Issues Associated with Cancer in Adolescence 1. Physical and Emotional Impact: • Body Image: Treatments like chemotherapy can lead to hair loss, weight changes, and scars, affecting body image and self-esteem. • Fatigue and Pain: Chronic fatigue and pain can interfere with daily activities, schooling, and social interactions. 2. Psychological Impact: • Depression and Anxiety: Adolescents may experience significant emotional distress, leading to depression and anxiety. • Isolation: They may feel isolated from peers due to hospital stays, treatment schedules, and physical limitations. 3. Social Impact: • Peer Relationships: Cancer can strain peer relationships and lead to feelings of being different or misunderstood. • Educational Disruptions: Frequent absences and cognitive side effects from treatment can disrupt education and future plans. 4. Identity and Independence: • Development of Identity: Adolescents are in a critical period of forming their identity, and a cancer diagnosis can disrupt this process. • Struggle for Independence: The need for dependence on parents and medical staff can conflict with their natural desire for independence. Developmental Period and Risk of Adjustment 1. Identity Formation: • Adolescence is a crucial time for developing a sense of self. Cancer can challenge an adolescent’s emerging identity, causing confusion and frustration. 2. Desire for Normalcy: • Adolescents typically strive to fit in and be accepted by peers. Cancer and its treatment can make them feel different and hinder their social integration. 3. Autonomy and Control: • Adolescents seek greater autonomy and control over their lives. Cancer can limit their independence, making them more reliant on parents and healthcare providers, which can lead to feelings of helplessness. 4. Future Orientation: • Adolescents are future-oriented, thinking about education, career, and relationships. A cancer diagnosis can create uncertainty about the future, leading to anxiety and altered life goals. 5. Emotional Regulation: • The emotional turbulence of adolescence can be exacerbated by the stress of a serious illness, making it harder for adolescents to regulate their emotions and cope effectively. Overall, the unique developmental challenges of adolescence, combined with the physical, emotional, and social impacts of cancer, can significantly complicate adjustment and increase the potential for risk in terms of psychological well-being and overall development. 63. Briefly describe four factors that contribute to concern for youngsters born infected with HIV. Answer: Factors Contributing to Concern for Youngsters Born Infected with HIV 1. Health Complications: • Frequent Illnesses: Children born with HIV are at higher risk for frequent and severe infections due to a weakened immune system. This can lead to recurrent hospitalizations and chronic health issues. • Developmental Delays: HIV can impact physical and cognitive development, resulting in delays in reaching developmental milestones. 2. Adherence to Treatment: • Complex Medication Regimens: Managing HIV requires strict adherence to antiretroviral therapy (ART), which can be challenging for children and their caregivers. Missing doses can lead to drug resistance and treatment failure. • Side Effects: ART can have significant side effects, impacting the child's quality of life and potentially leading to non-adherence. 3. Psychosocial Impact: • Stigma and Discrimination: Children with HIV and their families often face social stigma and discrimination, leading to isolation and psychological distress. • Mental Health: The chronic nature of HIV, coupled with social stigma, can contribute to mental health issues such as anxiety, depression, and low self-esteem. 4. Educational and Social Challenges: • School Attendance: Frequent medical appointments and health issues can disrupt school attendance, affecting educational achievement and social integration. • Peer Relationships: Stigma and health-related absences can hinder the development of peer relationships, leading to social isolation and difficulties in social development. 64. List 7 common activities required of diabetic children and families. Answer: Common Activities Required of Diabetic Children and Families 1. Blood Glucose Monitoring: • Regularly checking blood sugar levels using a glucometer to ensure they stay within the target range. 2. Insulin Administration: • Administering insulin through injections or an insulin pump to regulate blood sugar levels. 3. Diet Management: • Planning and maintaining a balanced diet, monitoring carbohydrate intake, and adjusting insulin doses accordingly. 4. Physical Activity: • Incorporating regular physical activity to help manage blood sugar levels and overall health. 5. Education and Training: • Learning about diabetes management, recognizing symptoms of high and low blood sugar, and knowing how to respond to them. 6. Medical Appointments: • Attending regular check-ups with healthcare providers to monitor the child’s health, adjust treatment plans, and receive ongoing education and support. 7. Emotional Support: • Providing emotional support to the child to help them cope with the psychological and social challenges of living with diabetes. 65. Briefly describe three different reasons adolescence appears to be a time of difficulty regarding adherence to medical regimens. Answer: Reasons Adolescence is a Time of Difficulty for Adherence to Medical Regimens 1. Desire for Independence: • Adolescents naturally seek greater autonomy and control over their lives. This desire for independence can lead to resistance against following structured medical regimens prescribed by parents or healthcare providers. 2. Social Pressures: • Peer influence and the desire to fit in with friends can result in adolescents neglecting their medical regimens. They may avoid taking medications or following dietary restrictions to avoid feeling different or being judged by their peers. 3. Developmental and Psychological Changes: • Adolescence is marked by significant physical, emotional, and cognitive changes. These changes can lead to forgetfulness, mood swings, and a lack of prioritization of health management, making it challenging for adolescents to consistently adhere to medical regimens. 66. Describe the methods used to assess pain and distress in youth undergoing medical procedures. Answer: Methods to Assess Pain and Distress in Youth Undergoing Medical Procedures 1. Self-Report Scales: • Numeric Rating Scale (NRS): Children are asked to rate their pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable. • Faces Pain Scale-Revised (FPS-R): Children choose a face that best represents their level of pain, ranging from a smiling face (no pain) to a crying face (worst pain). 2. Observational Scales: • FLACC Scale: Used for nonverbal children or those unable to self-report, assesses Facial expression, Leg movement, Activity, Cry, and Consolability. • N-PASS (Neonatal Pain, Agitation, and Sedation Scale): Used for infants, assesses behavioral and physiological indicators of pain and distress. 3. Behavioral Indicators: • Facial Expressions: Grimacing, frowning, or wincing. • Body Movements: Restlessness, guarding, or tensing. • Vocalizations: Crying, moaning, or verbal expressions of pain. 4. Physiological Measures: • Heart Rate: Increased heart rate can indicate pain or distress. • Respiratory Rate: Rapid or irregular breathing may signal discomfort. • Blood Pressure: Changes in blood pressure can be indicative of pain or distress. 5. Combined Approaches: • Multimodal Assessment: Combining self-report, observational, and physiological measures for a comprehensive assessment of pain and distress. • Parent or Caregiver Reports: Obtaining information from parents or caregivers about the child's behavior and verbalizations related to pain. 6. Contextual Factors: • Developmental Level: Consideration of the child's age and cognitive abilities when interpreting self-report or behavioral indicators. • Cultural Considerations: Awareness of cultural differences in how pain and distress are expressed and perceived. 7. Post-Procedure Assessment: • Follow-up assessment after the procedure to evaluate the effectiveness of pain management interventions and the child's recovery. 67. Describe some skills taught to assist children in coping with medical procedures. Give an example of emotive imagery. Answer: Skills Taught to Assist Children in Coping with Medical Procedures 1. Relaxation Techniques: • Deep breathing: Teaching children to take slow, deep breaths to help calm their body and mind. • Progressive muscle relaxation: Guiding children to tense and then relax different muscle groups to reduce tension and anxiety. 2. Distraction Techniques: • Providing a game, book, or toy to focus on during the procedure. • Engaging in conversation or storytelling to divert attention from the procedure. 3. Cognitive Behavioral Strategies: • Positive self-talk: Encouraging children to use positive affirmations or statements to reduce fear and anxiety. • Cognitive restructuring: Helping children reframe negative thoughts about the procedure into more positive or neutral thoughts. 4. Guided Imagery: • Guiding children to imagine a peaceful or calming place, such as a beach or forest, to help them relax and reduce anxiety. • Using storytelling or visualization techniques to create a positive and comforting mental image. 5. Modeling and Rehearsal: • Showing children videos or pictures of the procedure being performed in a calm and positive manner to familiarize them with the process. • Allowing children to practice coping strategies, such as deep breathing or positive self-talk, before the procedure. Example of Emotive Imagery Emotive imagery involves creating vivid mental images that evoke specific emotions. For example, a child preparing for a medical procedure might be guided to imagine a scenario where they are in a safe and comfortable place, such as lying on a soft cloud or floating in a calm ocean. They are encouraged to visualize this scene in detail, focusing on the sensations of warmth, peace, and relaxation it brings. This technique can help the child feel calmer and in control during the procedure. 68. What are the common antecedents to injury? Note those that are present in the youth, their peers, and their parents. Answer: Common Antecedents to Injury 1. Youth: • Risk-taking Behavior: Adolescents may engage in risky activities such as speeding, substance abuse, or not wearing seat belts or helmets. • Inexperience: Lack of experience or skills in certain activities, such as driving or using equipment, can increase the risk of injury. 2. Peers: • Peer Pressure: Influence from peers to engage in risky behaviors or activities. • Social Norms: Beliefs within peer groups that certain risky behaviors are acceptable or even desirable. 3. Parents: • Parental Supervision: Lack of supervision or involvement in children's activities can lead to higher risk of injury. • Parenting Style: Authoritarian or permissive parenting styles may not effectively teach children about safety or risk management. • Modeling Behavior: Parents who engage in risky behaviors themselves may inadvertently model these behaviors to their children. Specific Antecedents Present in Each Group • Youth: Risk-taking behavior, inexperience, lack of awareness of consequences. • Peers: Peer pressure, influence of social norms, modeling of risky behaviors. • Parents: Lack of supervision, ineffective parenting styles, modeling of risky behaviors. 69. What should a dying child and his/her family be told? What other needs do they have? Answer: What to Tell a Dying Child and Their Family • Honesty and Openness: Provide clear, age-appropriate information about the child's condition. • Empathy and Support: Express understanding and offer emotional support. • Respect for Wishes: Respect their decisions regarding care and treatment. • Pain and Symptom Management: Ensure the child's comfort with effective management. • End-of-Life Planning: Assist in making arrangements for care and location preferences. Other Needs of a Dying Child and Their Family • Emotional Support: Offer counseling and create opportunities for quality time together. • Spiritual and Cultural Needs: Respect beliefs and offer spiritual support if desired. • Practical Support: Assist with financial, legal, and funeral arrangements. • Communication and Information: Keep the family informed and encourage open communication. • Grief and Bereavement Support: Provide ongoing support and resources for grief and bereavement. Test Bank for Abnormal Child and Adolescent Psychology Rita Wicks-Nelson, Allen C. Israel 9781317351344, 9780205036066, 9780205901128
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