Saturday, March 29, 2014

Potential Affects of Childhood Cancer

Potential Affects of Childhood Cancer on Academic Achievement

Gorin and McAuliffe (2008) found long-term effects on a number of physiological and psychological functions as a result of childhood cancers. For example, deficits in neurocognitive and heart and lung functioning and secondary cancers are not uncommon. In addition, other effects such as hearing loss, impaired growth, osteopenia, and dental and oral problems have been observed (NCI, 2014). Moreover, surviving childhood cancers has potential residual effects that cause an increase in psycho-behavioral problems such as chronic overweight and obesity, smoking, and chronic fatigue (Eiser, 1998; Gorin & McAuliffe, 2008; Vannatta, Salley, & Gerhardt (2009). Contributing to these challenges, childhood cancer survivors experience depression, mood swings and inadequate social and psychological adjustment (NCI, 2014).

Some children, especially those who undergo treatment over a longer course of time, may suffer deficits in their neurological systems, which has obvious ramifications for thought and learning processes essential for students at any age, and these deficits have the potential to cause long-term challenges to learning (Gorin & McAuliffe, 2008; NCI, 2014; O'Leary, Krailo, Anderson, & Reaman, 2008). The late effects of surviving childhood cancer are not usually life-threatening, although they can deteriorate the individual's quality of life. For survivors of childhood cancers, these effects can take a toll on academic performance and increase the special needs of the student (Gorin & McAuliffe, 2008).

Affects of Childhood Cancer on Peer Relationships
Adding to academic challenges is the decreased ability of childhood cancer survivors to establish and maintain social relationships, such as relationships with peers (Boman & Bodegard, 1995). Gorin and McAuliffe (2008) found that as adults, these cancer survivors are less likely to establish intimate relationships. Hays and colleagues (1992) noted that survivors of central nervous tumors were predisposed to an increased severity of the late effects of childhood cancer survivors. Factors that increase psychosocial late effects are being female, the age at which the child was diagnosed, and being of lower socioeconomic status (Jacobs & Pucci, 2013). Some behaviors, such as risk taking behavior in adolescents and young adults was no different than the general population (Jacobs & Pucci, 2013).

Falling behind in school could have a definitive impact on peer relationships. If the child is placed in special education classes, he or she may be stigmatized and ostracized by the other students. In addition, survivors of childhood cancer are more likely to experience depression and anxiety, which is known to affect relationships (Jacobs & Pucci, 2013). Self-esteem seems to sustain damage when survivors are not comfortable with the effects of cancer on their bodies, especially if they have sustained a physical deficit from cancer treatments (Schwartz, Feinberg, Jilinskaia, & applegate, 1999). A lack of self-esteem has the potential for certain challenges in creating and maintaining relationships with peers.

Strategies to Help

Jacobs and Pucci (2013) found peer support during treatment helped patients interact with their peers and increased their ability for appropriate psychological development, including participating in intimate relationships and normal sexual functions. In particular Schwartz, Feinberg, Jilinskaia, and Applegate, (1999) developed an intervention that included group discussions, formal presentations, and activities that fostered self-esteem and the integration of the cancer experience into survivors' lives. The intervention helped the participants re-frame their quality of life. In effect, it "normalized survivors' concept of QOL [Quality of Life] so that it was increasingly similar to their age-matched cohort" (Schwartz, Feinberg, Jilinskaia, & Applegate, 1999, p. 352).

Perhaps the best strategy is to develop special education services and peer-related interventions during the cancer treatment, proactively intervening in patients' experiences (Mitby et al., 2003). Cancer clinics that specialize in childhood cancers, such as St. Jude's Research Hospital, provide classroom instruction, based on the child's school work. In addition, they offer school reintegration services to help children return to school including educating the child's classmates about the affected child's disease, side effects and other age appropriate information (St. Jude Research Hospital, 2014). Peer support during treatment, and school reintegration services seem critical for survivors' long-term psychological health.

Boman, K., & Bodegård, G. (1995). Psychological long-term coping with experience of disease and treatment in childhood cancer survivors. Acta Paediatrica, 84(12), 1395. doi:10.1111/j.1651-2227.1995.tb13576.x

Vannatta, K., Salley, C. G., & Gerhardt, C. A. (2009). Pediatric oncology: Progress and future challenges. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 319–333). New York, NY: Guilford.

Eiser, C. (1998). Practitioner review: Long-term consequences of childhood cancer. Journal Of Child Psychology & Psychiatry & Allied Disciplines, 39(5), 621.

Gorin, S. S., & McAuliffe, P. (2008). Implications of childhood cancer survivors in the classroom and the school. Health Education, 109(1), 25–48.

Hays, D.M., Landsverk, J., Sallan, S.E., Hewett, K.D., Patenaude, A.F., Schoonover, D., Zilber, S.L., Ruccione, K., Siegel, S.E. (1992), "Educational, occupational, and insurance status of childhood cancer survivors in their fourth and fifth decades of life", Journal of Clinical Oncology, Vol. 10 pp.1397-406.

Jacobs, L. A., & Pucci, D. A. (2013). Adult Survivors of Childhood Cancer: The Medical and Psychosocial Late Effects of Cancer Treatment and the Impact on Sexual and Reproductive Health. Journal Of Sexual Medicine, 10120-126. doi:10.1111/jsm.12050

Mitby, P. A., Robison, L. L., Whitton, J. A., Zevon, M. A., Gibbs, I. C., Tersak, J. M., ... Mertens, A. C. (2003). Utilization of special education services and educational attainment among long-term survivors of childhood cancer. Cancer, 97(4), 1115-1126. doi: 10.1002/cncr.11117

National Cancer Institute (NCI). (2014). Late Effects of Treatment for Childhood Cancer (PDQ®). Retrieved March 23, 2014, from

O'Leary, M., Krailo, M., Anderson, J., & Reaman, G. (2008). Progress in childhood cancer: 50 years of research collaboration, a report from the Children's Oncology Group. Seminars In Oncology, 35(5), 484-493.

Schwartz, C. E., Feinberg, R. G., Jilinskaia, E., & Applegate, J. C. (1999). An evaluation of a psychosocial intervention for survivors of childhood cancer: paradoxical effects of response shift over time. Psycho-Oncology, 8(4), 344-354.

St. Jude Research Hospital. (2014). School program presented by Target. Retrieved March 23, 2014, from

Age Appropriate Management of Childhood Diabetes

Curtis-Taylor (2011) found patient centered care fostered children's independence. In particular, it was important to help children develop an expertise about their illness and to support them in exploring and voicing their sense of powerlessness over their disease. This includes their social experiences such as feeling isolated and different from other children.

In the medical milieu, not including children from discussions on their disease is counterproductive and damaging to their ability to become capable participants in the management of their disease (Curtis-Taylor, 2011; Roper et al., 2009). Age differences are apparent during development that change the way children and adolescents manage their disease (Hema et al., 2009), although rather than making age-related assumptions that younger children cannot play a central role in disease management, parents and health care professionals should identify and utilize resources that will foster independence and autonomy from a young age. Although traditionally children have been perceived as incapable of understanding their disease, even the youngest children develop the ability to understand their disease based on their routine experiences of care and physical sensations they experience related to their disease (Curtis-Taylor, 2011). It seems appropriate to include young children in disease management and to provide ongoing assessments of their ability to self-manage based on observation and discussions with the child. From the assessment, parents can increase the child's disease management role incrementally as the child develops the ability to be successful in the undertaking.

Two Potential Barriers for Effective Management
As mentioned above, maintaining a perception of control fosters treatment compliance as well as overall outcomes. Skinner, John, & Hampson (2000) found personal models of illness are predictive of the adolescents' health, well-being, and their response to a health threat. A personal model is a general personalized and internalized perception of how the individual adapts to his or her illness based on beliefs and previous experiences (Skinner, John, & Hampson, 2000). For example, when adolescents believed their treatment regimens were effective, the implemented more effective self care. Additionally, adequate social support predicted better self care as well (Skinner, John, & Hampson, 2000; Vesco et al., 2010)). For these reasons, not being included in, or lacking an understanding of prescribed treatments and their effectiveness and a lack of social support could be detriments to adequate self management (Vesco et al., 2010).

Behavioral Strategy for Self Management

Typically, children and adolescents with diabetes do not experience disease-related stress as a central issue in their lives. They cope according to disease severity as well as the extent to which their disease is managed. Maintaining a sense of control over disease is a salient issue and affects compliance and outcomes (Hema et al., 2009). Age, too, has an effect on how children and adolescents manage disease. For example, younger children utilized distractions as coping mechanisms, while older children used cognitive skills, such as changing their attitudes.

Wysocki and colleagues (2008) found that family therapy helped some adolescents in coping with diabetes and increased their self-management by improving interfamily communication and teaching them how to implement problem solving as a way to change non-compliant behaviors. Many different interventions produce positive outcomes for children and adolescents with diabetes, but the most effective ones work to change targeted behaviors (Hampson et al., 2000). Regardless of the number of effective interventions, addressing the child or adolescent's individual needs, stressors, and treatment barriers is critical to the success of the intervention (Salmon, Hains, Fleischman, Davies, & Kichler, 2010).

Because Skinner, John, and Hampson (2000) found that developing a positive personal model was beneficial, I would include fostering the development of such a model in concert with teaching the adolescent how to access and develop resources such as social support systems, since adequate social support has been shown to be predictive of more effective self care (Skinner, John, & Hampson, 2000; Vesco et al., 2010). In addition, including the child or adolescent in discussions about the disease and individualized treatment plans is critical for the development of self management skills (Vesco et al., 2010).


Curtis-Tyler, K. (2011). Levers & barriers to patient-centered care with children: Findings from a synthesis of studies of the experiences of children living with type 1 diabetes or asthma. Child: Care, Health and Development, 37(4), 540–550.

Hampson, S. E., Skinner, T. C., Hart, J., Storey, L., Gage, H., Foxcroft, D., & … McEvilly, E. A. (2000). Behavioral interventions with adolescents with type 1 diabetes: How effective are they? Diabetes Care, 23(9), 1416–1422.

Hema, D. A., Roper, S. O., Nehring, J. W., Call, A., Mandleco, B. L., & Dyches, T. T. (2009). Daily stressors and coping responses of children and adolescents with type 1 diabetes. Child: Care, Health and Development, 35(3), 330–339.

Roper, S. O., Call, A., Leishman, J., Ratcliffe, G. C., Mandleco, B. L., Dyches, T. T., & Marshall, E. S. (2009). Type 1 diabetes: Children and adolescents’ knowledge and questions. Journal of Advance Nursing, 65(8), 1705–1714.

Salamon, K. S., Hains, A. A., Fleischman, K. M., Davies, W. H., & Kichler, J. (2010). Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): A pilot study. Primary Care Diabetes, 4(1), 47–55.

Skinner, T. C., John, M., & Hampson, S. E. (2000). Social support and personal models of diabetes as predictors of self-care and well-being: A longitudinal study of adolescents with diabetes. Journal of Pediatric Psychology, 25(4), 257–267.

Vesco, A. T., Anderson, B. J., Laffel, L. M., Dolan, L. M., Ingerski, L. M., & Hood, K. K. (2010). Responsibility sharing between adolescents with type 1 diabetes and their caregivers: Importance of adolescent perceptions on diabetes management and control. Journal of pediatric psychology, 35(10), 1168–1177.

Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., Sadler, M., & White, N. H. (2008). Randomized, controlled trial of behavioral family systems therapy for diabetes: Maintenance and generalization of effects on parent-adolescent communication. Behavior Therapy, 39(1), 33–46.

Ziaian, T., Sawyer, M. G., Reynolds, K. E., Carbone, J. A., Clark, J. J., Baghurst, P. A., & …French, D. J. (2006). Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma. Journal of Pediatrics and Child Health, 42(10), 596–600.

Taking Diabetes to School

           Third and fourth grade students are young enough to think in simple terms, but old enough to understand basic and more complex ideas (Clark, 2003). Presentations should be brief - a maximum of 15-20 minutes (Joslin Diabetes Center, 2012). It is critical to the success of the presentation that it offers simple basic facts. More detailed information is better presented when children ask for it, such as in a question and answer format. This is the reason for the question and answer section at the end of the presentation.

Peer Pressure and Socialization

Addressing peer pressure is important because as younger children become adolescents, peer pressure becomes a more salient issue. Teaching children about being helpful and not hurtful to children with diabetes may result in a more compassionate approach during adolescence (Salamon, Hains, Fleischman, Davies, & Kichler, 2010). Most children and adolescents with diabetes do not have psychological problems that differ from children without diabetes (Delamater, 2007; Hema et al,, Salamon et al., 2010). However, teaching children to be inclusive and tolerant of children with diabetes and other chronic diseases may have positive effect on their ability to socialize more appropriately with children and adolescence with diabetes during adolescence.

Since Curtis-Taylor (2011) found fostering independence was important for children with diabetes, it seemed a particularly salient issue for other children to understand that children with diabetes are not victims of their disease; they become experts and prefer taking control by becoming independent in the management of their illness. It seemed essential to present children with diabetes as experts who can self manage. Engaging other children in feeling comfortable enough to discuss the disease with children who have it, might become empowering and an important component in fostering appropriate socialization for children with the disease. In addition, since children with chronic disease may have a tendency to experience social isolation (Delamater, 2007), learning to feel comfortable as experts about their disease may foster independence (Curtis-Taylor, 2011).

Age Appropriate Teaching

Teaching children at age appropriate levels is critical to learning (Feild-Berner & Balgopal, 2011). Engaging them in discussion and activities help them understand more complex concepts. It is especially salient to educate children on the controllability of Type II diabetes, and that what they eat plays a central role in health (Feild-Burner & Balgopal, 2011). Teaching children about healthy food choices should be fun with activities and pictures that engage them rather than bore them (Feild-Burner & Balgopal, 2011; Koch, Barton, Whitaker, & Contento, 2007). Educating elementary school children may not provide enough support to change the children's risk factors for diabetes. However, teaching them in younger grades provides a foundation that may help them understand the effects of obesity and may foster their desire and ability to take control of their physical health by making healthy choices that will prevent obesity (Koch et al., 2007).


Clark, C. D. (2003). Juvenile diabetes. In In sickness and in play: Children coping with chronic illness (pp. 6–42). New Brunswick, NJ: Rutgers University.

Delamater, A. M. (2007). Psychological care of children and adolescents with diabetes. Pediatric Diabetes, 8(5), 340-348. doi:10.1111/j.1399-5448.2007.00318.x

Diabetes Research Institute. (2014). Explaining Diabetes to Kids. Retrieved March 18, 2014, from

Feild-Berner, N., & Balgopal, M. (2011). Knowledge is power: teaching children about type II diabetes. Science and Children, (3).

Hema, D. A., Roper, S. O., Nehring, J. W., Call, A. A., Mandleco, B. L., & Dyches, T. T. (2009). Daily stressors and coping responses of children and adolescents with type 1 diabetes. Child: Care, Health & Development, 35(3), 330-339. doi:10.1111/j.1365-2214.2009.00937.x

Joslin Diabetes Center, Inc. (2014). Classroom Presentation on Diabetes for Elementary School Age Children. Retrieved March 20, 2014, from

Koch, P., A.C. Barton, R. Whitaker, and I. Contento. 2007. Choice, control, and change: Using scientific evidence to promote healthful food and activity choices. Science Scope 31 (3): 16–19.

Salamon, K. S., Hains, A. A., Fleischman, K. M., Davies, W. H., & Kichler, J. (2010). Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): A pilot study. Primary Care Diabetes, 4(1), 47–55.

What is Diabetes?

Effectiveness of Childhood Coping

It is interesting to think about the differences between emotion- and problem-focused coping and the situations in which they are effective. For example, as in the case of childhood disease, problem-focused coping can be ineffective because it is not possible to exert control over disease (Carver, 2011). Problem-focused coping can, however, be valuable in finding effective ways to cope. Emotion-focused coping strategies are effective when unchangeable stressors must be managed (Baldacchino & Draper, 2001).

I work with children and adolescents with developmental and intellectual disabilities and their parents. I have found that even though problem solving has an important place in helping parents develop a working strategy, it is the emotion-focused coping strategies that enable them to change the negative and isolating thoughts associated with their stress (their child's condition).

Emotion-focused coping can be instrumental in the process of reevaluating unchangeable stressors, such as disease (Stanton, Kirk, Cameron, & Danoff-Burg, 2000). I find it interesting that children naturally utilize this form of coping. From Clark's (2003) perspective, though, it is not simply that they choose emotion-focused coping, but that it is likely their use of imaginal play that is foundational in their natural coping mechanisms.


Baldacchino, D., & Draper, P. (2001). Spiritual coping strategies: A review of the nursing research literature. Journal of Advanced Nursing, 34, 833-841.

Clark, C. D. (2003). Imaginal coping. In In sickness and in play: Children coping with chronic illness (pp. 91–138). New Brunswick, NJ: Rutgers University.

Carver, C. S. (2011). Coping. In R. J. Contrada & Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 221–229). New York, NY: Springer Publishing Company.

Stanton, A. L., Kirk, S. B., Cameron, C. L., & Danoff-Burg, S. (2000). Coping through emotional approach: Scale construction and validation. Journal of Personality and Social Psychology, 78(6), 1150-1169. doi: 10.1037//0022-3514.78.6.1150

Increased Prevalence of Childhood Asthma

My position is that the increased prevalence of asthma is a result of extrinsic environmental factors that include higher levels of environmental toxins, and intrinsic environmental factors such as the individuals' psychological environment, as well as their diet, level of stress and the health of their immune system. I would not, however, rule out medical practices and more efficient diagnostics as at least minimally contributory to the increase.

An abundance of research as well as traditional wisdom acknowledges environmental triggers or allergens as a cause of asthmatic symptoms (Parker et al., 2008; Priftis, Mantzouranis, & Anthracopoulos, 2009). However, a number of epidemiological studies demonstrate a relationship between diet and asthma. For example, the Mediterranean diet has been associated with a lower prevalence of asthma in school age children (Arvaniti et al., 2011; Batille, Garcia-Aymerich, Barraza-Villarreal, Antó, & Romieu, 2008; Chatzi & Kogevinas, 2009; Garcia-Marcos et al., 2007). This supports the idea that diet may be an important factor in the increase of asthma in children.

Asthma has been referred to as a psychosomatic illness, and stress has been shown to be a factor in its development. In mice, neonatal stress has been shown to permanently alter the immune system of offspring (Vig, Gordon, Thébaud, Befus, & Vliagoftis, 2010). Maternal stress during pregnancy causes changes in the unborn child's immune system (Wright, 2012). In particular, prenatal stress alters the child's antigen response, which is an underlying issue in asthma. Wright (2011) postulated "biological, psychological, and social processes interact throughout the life course to influence disease expression" (p. 1), and that stress, especially psychosocial stress in early life, contribute to lung diseases, such as asthma. The idea of psychological stress and the epigenetic mechanisms of gene expression as contributory in the development of asthma should not be overlooked. Perhaps children are under increased stress which would contribute to the increase in childhood asthma.

Regarding the immune response and the immune system in general, Marshall and Agarwal (2000) found that chronic psychological stress is associated with the proliferation of hyperactive cytokines, which creates cell mediated immune responses. Stress does not simply suppress the immune system, but alters it in a way that creates the inflammatory environment that is characteristic of allergic reactions and asthma (Marshall & Agarwal, 2000). This, of course, is not a process that takes place in every individual under stress, but these immune imbalances may favor an inflammatory response, such as asthma, in susceptible individuals. It may be possible that modern day living puts additional stress on the immune system, or causes its dysfunction, which may lead to an increase in childhood asthma.

Although the exact underlying mechanisms of the onset of asthma remain unclear, it has been well-established that cytokines and immune cells play a central role in the onset of asthma (Zhang et al., 2013). This lack of clarity as well as the individual variables in triggers, symptom severity, and effective treatments make asthma a challenging, albeit common childhood illness.


Arvaniti, F., Priftis, K., Papadimitriou, A., Papadopoulos, M., Roma, E., Kapsokefalou, M., & ... Panagiotakos, D. (2011). Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10-12 years old children: the PANACEA study. Pediatric Allergy And Immunology: Official Publication Of The European Society Of Pediatric Allergy And Immunology, 22(3), 283-289. doi:10.1111/j.1399-3038.2010.01113.x

Batlle, J. D., Garcia-Aymerich, J., Barraza-Villarreal, A., Antó, J. M., & Romieu, I. (2008). Mediterranean diet is associated with reduced asthma and rhinitis in Mexican children. Allergy, 63(10), 1310-1316. doi: 10.1111/j.1398-9995.2008.01722.x

Chatzi, L., & Kogevinas, M. (2009). Prenatal and childhood Mediterranean diet and the development of asthma and allergies in children. Public Health Nutrition, 12(9A), 1629. doi: 10.1017/S1368980009990474

Garcia-Marcos, L., Canflanca I. M., Garrido, J.B., Varela, A. L., Garcia-Hernandez, G., Guillen Grima, F., ...Blanco-Quiros, A. Relationship of asthma and rhinoconjunctivities with obesity, exercise and mediaterranean diet in Spanish schoolchildren. (2007). Thorax, 62(6), 503-8.

Laureate Education, Inc. (Executive Producer). (2012). Child and adolescent health: Living with asthma. Baltimore, MD: Author.

Marshall, G., & Agarwal, S. (2000). Stress, immune regulation, and immunity: applications for asthma. Allergy And Asthma Proceedings: The Official Journal Of Regional And State Allergy Societies, 21(4), 241-246.

Priftis, K. N., Mantzouranis, E. C., & Anthracopoulos, M. B. (2009). Asthma symptoms and airway narrowing in children growing up in an urban versus rural environment. Journal of Asthma, 46(3), 244–251.

Vig, R., Gordon, J., Thébaud, B., Befus, A., & Vliagoftis, H. (2010). The effect of early-life stress on airway inflammation in adult mice. Neuroimmunomodulation, 17(4), 229-239. doi:10.1159/000290039

Wright, R. (2011). Epidemiology of stress and asthma: from constricting communities and fragile families to epigenetics. Immunology & Allergy Clinics Of North America, 31(1), 19-39. doi:10.1016/j.iac.2010.09.011

Zhang, Y., Luan, B., Wang, X., Qiao, J., Song, L., Lei, R., & ... Liu, Y. (2013). Peripheral Blood MDSCs, IL-10 and IL-12 in Children with Asthma and Their Importance in Asthma Development. Plos ONE, 8(5), 1-9. doi:10.1371/journal.pone.0063775