Session Eight (Children and Families with Severe Conditions) Flashcards
How does a child’s understanding of illness change as they age?
3-7: Concrete understanding of the world around them, understand from direct experiences through copying and repeating. Understand their body in terms of what they can see, feel, put in and take out. Magical thinking.
7-11: Able to understand more about what is in the body and how parts connect. Likely to accept what they are told without questioning. Can understand germs but less likely to understand more complex ideas like cancer. Less magical thinking.
11+: Adult like comprehension of the body, but lacking full brain/emotional development. Will still obey an authority figure without questioning.
16+: Assumed to be able to understand, retain and evaluate information, and therefore can give consent. However still not emotionally mature.
What is Gillick competence?
Cases where a child below the age of 16 is deemed to be capable of understanding and making medical decisions.
What issues can occur as a result of parents refusing to tell their kids anything about their condition?
Two main issues are common:
- Children don’t understand they are unwell, therefore don’t understand why they have to be in hospital or why doctors want to (e.g.) draw blood from them, therefore do not comply.
- Children catch a snippet of information from a parent/doctor and extrapolate from there to come to a conclusion far more anxiety inducing than if the parent had simply spoken to the child.
For these reasons paediatric psychologists recommend explaining to children SOME of the details around their illness.
What is important to consider as children under psych care age into adolescence?
- Age at which they are emotionally mature is highly variable
- Once you switch from paediatric to adult care, people become a lot less lenient when it comes to missed appointments or poor compliance.
What are the 3 main psychiatric therapies used in paediatric psych care?
- CBT (only really mild-moderate)
- Narrative therapy
- Systemic family therapy
Outline how CBT is used in paediatric psychology settings?
- Most common in NHS, time limited and cost effective
- Only really useful for mild to moderate depression and anxiety
- Often inappropriate for paediatric anxiety, CBT is very effective at tackling irrational worries, a lot of the cases paed psych get involved with are entirely rational
- 4 Components; Physical symptoms, Behaviours, Thoughts, Feelings
- Physical symptoms can be helped through relaxation methods
- Behaviours such as avoidance can be treated through exposure
- Thoughts and feelings can be managed with more traditional CBT methodology
- Worry trees can be helpful (Can I do anything about it Y/N….)
Outline how Narrative Therapy is used in paediatric psychology settings?
- Seeks to separate the problem from the individual by externalising the issue
- In doing so, gives the patient a sense of agency and control.
- Works on the idea of Social Constructivism; that all reality is constructed between individuals, and therefore can be altered.
- A common NT method is asking the child to draw their worry/frustration/illness and imagine it shrinking or growing. This allows them to reimagine it as a totally separate being that can be confronted/ fought against.
- Works on the child’s inherently playful and imaginative nature
Outline the method of Systemic Family Therapy in paediatric psychology?
- Works on the idea that problems are held within relationships, therefore to solve a problem you need everyone who is affected by that problem to be present in the solution.
- Who is experiencing what problem (anxiety, depression, sleep issues…)
- Can’t focus solely on the patient or the primary care giver because further family can undo that work with their worries.
- Attempts to look at why a person might be having a given issue in the context of their gender, religion, age, ethnicity, employment status etc…
What psych issues might present when dealing with a dying child?
Obviously, depression, anxiety, PTSD and potentially substance use for all involved.
- Child; difficulty understanding death, depression in older children, attempting to protect parents through coping mechanisms
- Parents; pressure to make life bearable for child, pressure to appear brave, relationship strain, different coping methods, pressure to give over children sufficient attention, financial issues
- Staff; difficulties that arise from pressure to make life bearable fro children, difficulty in balancing being friendly with getting over involved, pressure to suppress emotional response
- Siblings; lack of attention, death anxiety through fear same condition will affect them
