What is the terminology?

Physical disorders that are influenced by psychological factors have been called psychosomatic disorders in the past . In DSM-II this term had been replaced by psychophysiological disorders and in DSM-III this term had again been changed to psychological factors that influence physical conditions. In the DSM-IV this was transformed into psychological factors that influence medical conditions . Now in the DSM-V there is a new chapter called somatic symptoms and related disorders. This includes the psychological factors category that affect other medical conditions. These adjustments are the result of the discussion about the relationship between body (soma) and mind (psyche). During the 20th century, the interest in the effects of psychological processes on the body has resulted in the development of psychosomatic medicine. It became clear that many physical complaints are influenced by psychological factors. Researchers started with psychogenesis: the identification of the psychological cause of physical disorders. More attention is now being paid to multicausality: the idea that biological, social and psychological factors contribute to health. This perspective is holistic and assumes continuous interactions between influences. Pediatric psychology is the field that focuses on these processes in children and adolescents.

What is Asthma?

In asthma there is a hypersensitivity of the airways to different stimuli. The airways become chronically inflamed and narrower. This causes breathing problems. Serious attacks (status asthmaticus) can be life threatening. The breathing problems and the danger of serious attacks can lead to anxiety for the patient and his family members.

About 10% of children suffer from asthma. The disorder is extra common in children who are poor, live in an urban area and / or belong to a minority group. A bright spot is that asthma can be temporary.

Research shows that genetic factors influence the risk of asthma. In addition, other factors most likely play a role. People who have asthma may be exposed to factors that influence the chance of an asthmatic attack. These influences are considered as triggers or irritants instead of as direct causes of asthma. Every individual has different triggers and over time triggers can change for the same individual. Repeated respiratory infections can play a role in the development of asthma and viral respiratory infections can lead to an asthmatic attack or worsen its severity. An allergy can also increase the chance of an attack. For example, some children are allergic to dust and get an asthmatic attack more quickly when they are in a dusty room. Physical factors, such as smoking and exercising, can also contribute to shortness of breath.

Asthma used to be considered a disorder with psychological causes and was called asthma nervosa. It is now clear that psychological or family factors cannot play a causal role in asthma. However, it has been shown that psychological factors can provoke asthmatic attacks. Examples are the home environment (such as dust), activities of family members (such as smoking) and stress (such as a divorce). However, the child's asthma can also affect the family. In this way parents can experience more anxiety, work less and have more medical costs. In addition, brothers and sisters may receive less attention.

The treatment of asthma includes pharmacological and psychological components. Families are informed about the triggers of asthmatic attacks and the consequences of asthma. Although psychological variables do not cause asthma, treatment can help parents and children to influence the frequency and symptoms of asthmatic attacks.

How does adjustment to chronic diseases factor in?

Chronic diseases have a negative influence on both the person suffering from the disease and the family of this person. Chronic diseases and related life experiences increase the risk of adjustment problems. The adaptation to a chronic disease is influenced by various variables. Examples of this are child characteristics (such as coping skills), family characteristics, disease characteristics (such as the severity of the disease and the functional independence of the child) and environmental characteristics (such as school characteristics and health care).

Although the research findings are inconsistent, some studies suggest that there is a connection between the severity of the disease and the extent to which a child adjusts. However, the relationship is complex and may depend on the perception of the child and family on the severity of the disease. The adjustment can also be influenced by the child's attitude and the degree of stress experienced by the child and the family. Adjustment may also be related to the degree of functional limitation: how severely the child is restricted by the disease. Functional limitations can affect how often the child cannot go to school, relationships with friends or other aspects of the child's functioning. However, interpreting the influence of disease characteristics on adaptation is difficult, as it cannot be experimentally investigated. In addition, the predictive capacity of disease characteristics is not strong. It is useful to use a normative approach that integrates disease factors with stress, risk and resilience factors in aetiological models for young people without chronic illness.

Family factors are also related to the psychological adjustment of chronically ill children. Examples of this are parenting behaviour, parental depression, disrupted family life and marital conflict. Family factors and disease characteristics do not work independently of each other, but the adaptation of children with a chronic disease is influenced by an interaction between the two.

Why is cancer important?

In the past, cancer was considered a fatal disease, but because of the increased chances of survival, cancer is now more often seen as a chronic disease. Cancer treatment is often long, intensive and painful. Children with cancer and their families must learn to cope with the disease. The effects of the disease and treatment are related to the developmental period of the child. In adolescence, cancer can interfere with the development of autonomy because they depend on family members and medical staff. It can limit their social life and interfere with the development of close interpersonal relationships.

Children who have overcome cancer through chemotherapy can still be confronted with the negative consequences of this therapy for a long time. They have a greater chance of physical disorders, such as heart problems and growth and fertility problems. Sometimes these problems only manifest themselves later in life.

What are other diseases/disorders?

HIV or AIDS

Although therapy can be used to slow the progression of HIV, children infected with HIV have a greater risk of developmental and neurocognitive problems. If neurological problems occur at school age, this can lead to learning, language, concentration, social and emotional problems. These problems are probably not only the direct consequence of the disease but also of the medical treatments and the stress associated with adapting to a chronic disease.

Diabetes

In the past, the aim of psychological treatments for people with a medical disease was to reduce physical complaints. However, this treatment method proved to be ineffective. The term compliance (adherence of compliance) refers to the extent to which a child (or the child's family) performs medical treatments, such as taking medication.

Diabetes is one of the most common chronic diseases among children. Type I diabetes occurs when the pancreas does not produce enough insulin, so it is necessary to inject insulin. Type I diabetes often develops during childhood and is therefore also called child diabetes. The exact cause of this disease is unclear, although genetic factors seem to be important. Type II diabetes occurs when insulin is not absorbed into the body. In the past this type of diabetes was mainly found in adults, but nowadays many children also suffer from an increase in obesity.

Both forms of diabetes increase the risk of problems with the nervous system, heart, kidneys and eyes. The child and the family have to adjust their life pattern to the disease, because the diet, daily insulin shots, monitoring of urine and measuring blood glucose levels must be taken into account. The daily dose of insulin must be adjusted to the blood sugar level, meals, sports, emotional state and physical health. The child must be sensitive to the signs of hyperglycaemia (too high amounts of glucose in the body) and hypoglycaemia (too little glucose in the blood). Signals of this are irritability, headache, shaking, weakness and (if not noticed in time) fainting and seizures. Symptoms of hyperglycaemia and hypoglycaemia are different per person and this makes it difficult to identify them.

The first step in treating diabetes is gaining control of the disease. Early treatment increases the chances of child compliance and reduces problems with diabetic control. To increase compliance, treatment programs often combine different strategies, such as informing, learning skills, and promoting family involvement. First, the parents and the child are informed about the disease. It must also be assessed whether the child has sufficient knowledge and skills to assess his or her own urine and to measure glucose. Questionnaires are often used to find out how much the child knows about diabetes. However, compliance is not only a matter of accurate knowledge, but also requires that the prescribed tasks are performed accurately and consistently.

There are various factors that influence compliance. An example of this is the level of development. For example, children under the age of 9 often find it difficult to measure exactly how much glucose they need and to inject insulin. In general, knowledge and skills increase with age. During puberty, the child is often less able to cope with his or her illness. For example, the adolescent overestimates how much he or she knows about diabetes and the extent to which he or she has the disease under control. During puberty, it is important that parents remain involved with their child to check whether he or she has the disease under control. Social and emotional factors, such as peer acceptance and participation in activities, are also related to reduced compliance. Children with diabetes often do not want to be different from others. Thus, there are also often conflicts with parents about independence.

Psychological treatment of chronic pain

The use of relaxation techniques and biofeedback to treat headaches is an example of an attempt to change physical functioning through psychological interventions. With biofeedback , a special device provides immediate feedback to a person about a particular biological function. Feedback is often given by means of a signal, for example a light signal, a tone or an image. This can ensure relaxation. Research shows that biofeedback, relaxation techniques and a combination of both are effective in reducing headaches in children.

Sorrow/Pain

The term distress refers to pain, fear and other negative feelings. There are three components to suffering: cognitive-affective, behavioural and physiological. Self-reports are often used to study the cognitive-affective aspect of suffering. Because pain is a subjective experience, it is best for someone to judge for themselves when he or she experiences pain. Older children can describe pain well and that is why they use questionnaires and interviews more often. However, very young children often have difficulty in differentiating between different degrees of pain. Faces can be displayed at this age with facial expressions ranging from neutral or cheerful to frowning. The behavioural component of suffering is often measured by observing children. Little is done to assess the physical component of suffering.

Coping

There are different ways to teach children to cope with the pain associated with their chronic illness or with the treatment they receive. First of all, it is important to prepare the child well by giving him or her information, because unexpected stress is worse than predictable stress. This information must be transmitted in an understandable manner.

Parents also play an important role. They can use strategies to distract the child or to help the child use coping strategies. If parents are very focused on symptoms or are anxious, this can increase the child's suffering and his distraction techniques are not effective. The behaviour of the practitioner also influences the child. If children feel that they are able to control the environment during treatment, this reduces their suffering.

Children can be taught to cope with pain and suffering through cognitive behavioural techniques, such as breathing exercises. They also learn distraction techniques. An example of this is emotional imagery, where images are used to reduce anxiety. Feelings of fear are, as it were, transformed into positive feelings. A child who is afraid of a puncture can, for example, be told that Superman knows that the child is incredibly strong and that he wanted to test how well the child can withstand a puncture. Another example is the creation of a pleasant image, such as a day at the beach, which is incompatible with experiencing pain.

Preparation for hospitalization

Admission to the hospital can have negative effects. These days, the child and parents are often prepared in advance for hospitalization. Interventions often combine modelling with explicit learning of coping techniques.

What do you do with the mental state of a dying child?

Some children are chronically ill and have a small chance of survival. A big question is how to prepare a child for death. Among other things, account must be taken of what the child knows about death. A child's ideas about death are influenced by experiences, family attitudes, and cultural factors. Cognitive development plays a major role in the changing ideas about death. For example, young children think that death is reversible. At the age of 5, children are aware that death is irreversible, but they think that dying can be avoided. Around the age of 9, children become aware of the mortality of people.

The child's family should also be aware of the severity of the child's disease. They must have a healthy balance between hope for a cure and the acceptance of the (possible) death of the child. It is difficult to prepare parents for the death of their child, while they still have to support their child emotionally and guide them through the treatment. When it becomes clear that a child is about to die, the focus must be on making the best possible use of the remaining time. It is also important to continue supporting the child's family after the child's death.

It used to be said that it was better not to tell the child that he or she was dying. This would only make the child feel miserable. These days this idea is no longer supported. When telling that the child is dying, the level of development of the child, past experiences and cultural factors must be taken into account though.