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Psychosocial issues in the child with chronic conditions

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Abstract

Psychosocial issues in children, adolescents and families who suffer with chronic illnesses require careful identification and treatment. Since more of these young people survive into adulthood, their risk of psychosocial distress and psychiatric illness is increased, although many adapt well. The literature is vast, but limited in its usefulness: criteria for the variables described, including chronicity and severity, are poorly defined; outcome measures are not standardized; and few randomized controlled clinical trials exist. This chapter focuses the attention of physicians on overt and covert signs of psychosocial distress in the patient and family with chronic illness. Common issues for all chronic diseases are discussed and a non-categorical approach is taken. The importance of the family as a focus of intervention is highlighted. The meaning and treatment of unexplained medical symptoms, non- adherence with treatment recommendations, school refusal, sexuality and substance use and abuse are discussed.

Section snippets

Psychosocial aspects of chronic illness

The study of the psychosocial aspects of specific diseases has been replaced by increasing documentation of various aspects of psychological and psychosocial effects associated with chronic disease in general.7., 9., 10. This non-categorical approach acknowledges the similarities among chronic illnesses. The nature of the onset and course of the illness, the potential fatality of the illness and the degree of incapacitation are important factors in understanding the impact of chronic illness in

The family as patient

The way the family copes with the child's condition is one of the most powerful predictors of the child's psychosocial adjustment and adaptation to the illness.23., 24., 25. Two influential studies26., 27. noted that the most powerful predictor of psychological functioning in chronically ill children was family functioning. Wolman et al28 looked at family connectedness as a measure of emotional well-being and investigated whether adolescents with chronic conditions (n=1683) and those without (n

Signs of psychosocial distress

Functional impairment in young people with chronic illness may be a result of psychosocial distress or psychiatric illness, which may present in covert forms. In our clinical experience there are four common presentations, found singly or in combination, that may alert the physician to the presence of underlying psychosocial issues:

  • 1.

    Medical symptoms that cannot be explained by organic factors alone.

  • 2.

    Poor adherence to treatment recommendations (non-compliance).

  • 3.

    School refusal.

  • 4.

    Engagement in risky

General principles

There is a paucity of literature evaluating the efficacy of psychosocial interventions for the paediatric medically ill population.72 Very few randomized controlled psychosocial treatment trials exist. In many studies flaws in the research methods are common, including the lack of control groups, non-specific outcome measures, small sample sizes and the lack of a longitudinal perspective.

In an important meta-analysis of the effectiveness of psychological interventions for children and

Summary

Psychosocial factors in chronic illness in the paediatric population may impede optimal outcome. Overt and covert adjustment problems and psychiatric illness may present as unexplained medical symptoms, non-compliance with medical treatment, school refusal and high-risk behaviours. The prevalence of underlying psychiatric illness within these presentations is unknown.

These signs may alert the physician to the presence of underlying issues in the child and/or the family. Before referral to a

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