Pediatric near-death experiences

A review of one previously reported and three new pediatric near-death experiences (NDEs), in which the experiencers were interviewed as children, suggests that the childhood core NDE as described by Melvin Morse and colleagues may be expanded to include feeling pain-free, seeing a light at the tunnel's end, entering the light, and time alteration. These cases also suggest that the life review may be a function of chronological age.     

Factor Structure of the Pediatric Symptom Checklist with a Pediatric Gastroenterology Sample

Pediatric gastrointestinal disorders are commonly experienced by youth and have been shown to be associated with increased rates of psychosocial difficulties. Aim of the current study was to extend development of the Pediatric Symptom Checklist (PSC), a brief parent-completed measure designed to assess children’s behavioral and emotional functioning, by examining its factor structure in a pediatric gastroenterology sample. Parents of 176 children ages 4–16 years visiting a pediatric gastroenterologist completed the PSC. The factor structure of the PSC was examined using principal component analysis. Parallel analysis was utilized to determine the number of factors to retain and indicated that three factors existed within the data. A principal component analysis with varimax rotation identified factors measuring internalizing, externalizing, and attention difficulties. The three factors that emerged on the PSC provide initial support for the utility of the PSC in pediatric gastroenterology clinics.     

Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children’s Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations—parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists’ practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.     

Family Functioning in Pediatric Trichotillomania

Little is known about how pediatric trichotillomania (TTM), a clinically significant and functionally impairing disorder, is impacted by, and impacts, family functioning. We explored dimensions of family functioning and parental attitudes in a sample of children and adolescents who participated in an Internet-based survey and satisfied conservative diagnostic criteria for TTM (ages 10–17, n = 133). Analyses reveal trends toward higher levels of dysfunction in families of TTM youth relative to normative samples, although no differences achieved statistical significance. However, scores on the Family Assessment Measure and the Attitudes Toward My Child scales were similar to those in clinical samples of youth with cystic fibrosis, an eating disorder, or an anxiety disorder. While these results indicate that family functioning and parental attitudes in TTM were not generally or extremely problematic, family issues may nevertheless warrant particular clinical evaluation and attention in more severe TTM cases.     

Collaborating With Pediatric Gastroenterologists to Treat Co-Occurring Inflammatory Bowel Disease and Anxiety in Pediatric Medical Settings

Children and adolescents with inflammatory bowel disease (IBD) have distinct physical and emotional challenges that may place them at risk for developing anxiety and that may impede their receipt of mental health treatment. Only a handful of studies have applied empirically validated cognitive behavioral therapy (CBT) to IBD-related issues and no studies have examined the benefit of CBT for anxiety disorders in pediatric IBD. The aim of this paper is to describe a newly adapted cognitive behavioral treatment protocol, Treatment of Anxiety and Physical Symptoms related to IBD (TAPS + IBD), that has been tailored to concurrently address anxiety, including IBD-specific anxiety, and disease management in children and adolescents with IBD in pediatric medical offices. Two case studies are presented to demonstrate treatment implementation and preliminary assessment data. General considerations for health providers working with youth with comorbid anxiety and IBD from a multidisciplinary perspective and future research directions are provided.     

Subjective Well-Being in Pediatric Oncology Patients

Using negative and positive measures of subjective well-being (SWB), we compared reports of 29 youth with cancer to a matched control sample of 29 youth. Youth with cancer did not differ from healthy controls on self-report measures of life satisfaction, hope, positive affect, or negative affect. Scores on measures of hope were positively correlated with time since diagnosis; none of the other SWB variables was significantly related to time since diagnosis. Except for negative affect, moderate correlations were found between parents’ reports of their own SWB and their youths’ self-reported SWB. Parents’ estimates of their youths’ SWB were also moderately associated with youth self-reports, except for negative affect. Parents of youth with cancer and their youth may use different criteria for reporting the nature and frequency of negative affect, but use similar criteria for reporting positive affect and other positive measures (hope, life satisfaction). Implications for more comprehensive assessments of the well-being of pediatric oncology patients are discussed.     

心理辅导室的建立与小儿外科

手术是小儿外科的主要治疗手段,又是一个创伤过程,同时也是一个心理应激过程,对于患儿来说这种应激会使其产生恐惧心理.同时小儿外科工作具有双重性,不仅要为患儿服务同时还需满足家长不同层次的心理需求.所以有必要在小儿外科科室内建立一个系统的心理辅导机构即心理辅导室来做好家长及惠儿的心理疏导.     

Perfectionism in Pediatric Anxiety and Depressive Disorders

Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.     

The Excitation-Adaptation Model of Pediatric Chronic Illness

This article examines the value of the psychosomatic family model for the study of chronically ill children. Four conceptual problems arise in the discussion of this model: the unidirectional causality of the model; the function of the sick child for the family system; the pathology of the family characteristics; and the disease type. In the present study, we propose (a) that a distinction be made between uncontrolled and controlled forms of disease, and (b) that the family characteristics of "cohesion" and "adaptation" be examined in relation to the parental capacity for problem solving and the acceptance or rejection of the child by the parents. This is shown by means of empirical research. In this empirical study, 20 families with a child suffering from controlled asthma are compared with 20 families with a child suffering from uncontrolled asthma. Contrary to the assumptions derived from the psychosomatic family model, the results show significantly more cohesion and structure in the group with a child suffering from controlled asthma. The findings from this study are integrated in a new model for the study of chronic childhood illness —"the excitation-adaptation model." In this model, two circular processes are emphasized involving (a) the progress of the illness and the way in which parents and child deal with medication and medical advice (therapy compliance), and (b) the factors influencing the therapy compliance on the part of the parents, the family, and the child. By studying these factors in connection with the management of the illness, it should become clear whether family characteristics are adaptive or pathological.     

Pediatric neuropsychiatric characteristics of behaviorally abnormal children

By means of integrative medical-psychological examinations in children with abnormal behaviour we found pathological signs in the ratings of parents and teachers, in the concentration efficiency, in the rate of impulsivity and in those cases in which there were mild symptomes of brain damage in the early childhood. In the intellectual and motorial efficiencies and in selfratings we could'nt establish any change compared with normal population.     

Neuropsychological Aspects of Pediatric Sickle Cell Disease

Sickle cell disease (SCD), a class of genetic disorders characterized by abnormal, sickled red blood cells, is a chronic illness that results in progressive cerebrovascular disease. Neurocognitive sequelae of clinically apparent cerebrovascular accidents in children with SCD are characterized by pervasive impairments, including decrements in general intellectual functioning, language and verbal abilities, visual-motor and visual-spatial processing, memory, academic achievement, and processing of subtle prosodic information. In contrast, subtle neurocognitive deficits in the areas of attention and concentration, executive function, and visual-motor speed and coordination appear to be associated with silent infarcts that are not necessarily detected on physical examination. Investigation of the disease course and associated neurocognitive sequelae suggest a disease-specific model of neuropsychological impairment. Recommendations are made for clinical and research efforts in the field of pediatric neuropsychology.     

Acute Intellectual Effects of Pediatric Head Trauma

The current study compared Wechsler Intelligence Scale for Children-III (WISC-III) performances of 30 children who sustained head injury with the performance of orthopedic controls matched on gender, age, race, and parental education and occupational attainment. Children were followed during initial hospitalization, trauma severity variables were recorded, and duration of posttraumatic amnesia (PTA) was determined by serial testing of mental status. The WISC-III was administered immediately following resolution of amnesia. Although the majority of patients sustained mild injuries, children with head injuries obtained significantly lower IQ and factor scores than nonneurologically injured children. Consistent with past research, performance-based scores including Performance IQ, Perceptual Organization, and Processing Speed were more sensitive to head trauma than their verbal counterparts. Standardized measurement of PTA appeared to be a better predictor of IQ status following injury than Glasgow Coma Scale score on admission or length of unconsciousness.     

心理辅导室的建立与小儿外科

手术是小儿外科的主要治疗手段,又是一个创伤过程,同时也是一个心理应激过程,对于患儿来说这种应激会使其产生恐惧心理。同时小儿外科工作具有双重性,不仅要为患儿服务同时还需满足家长不同层次的心理需求。所以有必要在小儿外科科室内建立一个系统的心理辅导机构即心理辅导室来做好家长及患儿的心理疏导。