Sunday, July 13, 2014

Children's Role in Decision-Making

At age 15, Jake is old enough to play a major role in his health decisions, and I would advocate for him to maximize that role, but not without a substantial education of the risks of making changes in his current prescribed medications. During adolescence, children learn to think abstractly, which would provide Jake with the ability to understand the disease and the effects reducing or changing medications could have on his life functioning (Piaget & Inhelder, 1947). I believe advocating for Jake is important. The prevalence of depressive symptoms in epileptic children and adolescents is as high as 39.6% and the perception of living with separation from one's peers and the experience of living a sub-normal life may contribute to the onset of depression (Dunn, Austin, & Huster, 1999; Seyfhashemi, & Bahadoran, 2013). Some research has identified depression in the adolescent epileptic population as high as 75% (Thome-Souza et al., 2002). The presence of depressive symptoms has been described as a co-morbidity of epilepsy because of this high rate.

Although it may not be possible to manage Jake's epilepsy with a different medication plan, Jake and his care team should discuss his options. In addition to any medication changes made for Jake, including him in the discussion and decision making and giving him a sense of control over his body, may give him a sense of ownership, which could contribute to a more positive outlook and experience. I would recommend that Jake's care team consult with a specialist at a leading teaching hospital to ensure Jake is prescribed the most appropriate medication with the lowest number of side effects. New classes of drugs may provide Jake with a choice in medications. For example, the new drug perampanel effects different pathways than many of the anti-epileptic drugs, and for some patients relieves them of unmanageable side effects (Shih, Tatum, & Rudzinski, 2013). There are, of course, side effects to most drugs.

                                                               Family Strategies

I am partial to family therapy. Glueckauf and colleagues (2002) found that although family therapy, rather than a therapy group, created a stronger therapeutic bond between therapists and adolescents There was, however, no difference in the benefit to the mothers. Deidrick, Grisson, and Farmer (2009) agree that family therapy can be beneficial for family with a chronically ill child. Although I believe group therapy would be beneficial for all members of the family, I think it is important, especially for an adolescent like Jake, to utilize a strategy that will most benefit him. The single family therapy would be my choice for Jake and his family, but not before in depth discussions on his medication alternatives and options.

Deidrick, K. K., Grisson, M. O., & Farmer, J. E. (2009). Central nervous system disorders: Epilepsy and spina bifida as exemplars. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 350–365). New York, NY: Guilford.

Piaget, J. & Inhelder, B. (1947) Diagnosis of mental operations and theory of the intelligence. American Journal of Mental Deficiency, 51(3), 401-406.

Sachs, H., & Barrett, R. P. (1995). Seizure disorders: A review for school psychologists. School Psychology Review, 24(2), 131–145.

Seyfhashemi, M., & Bahadoran, P. (2013). Depression in Children and Adolescents with Epilepsy: a 15 Year Research Review of Prevalence, and Demographic and Seizure Related Correlates. Iranian Journal Of Pediatrics, 23(1), 1-7.

Shih, J. J., Tatum, W. O., & Rudzinski, L. A. (2013). New drug classes for the treatment of partial onset epilepsy: focus on perampanel. Therapeutics & Clinical Risk Management, 9285-293. doi:10.2147/TCRM.S37317

Dunn, D. W., Austin, J. K., & Huster, G. A. (1999). Symptoms of depression in adolescents with epilepsy. Journal of the Academy of Child & Adolescent Psychiatry, 38(9), 1132–1138.

Glueckauf, R. L., Liss, H. J., McQuillen, D. E., Webb, P. M., Dairaghi, J., & Carter, C. B. (2002). Therapeutic Alliance in Family Therapy for Adolescents with Epilepsy: An Exploratory Study. American Journal Of Family Therapy, 30(2), 125-139. doi:10.1080/019261802753573849

Hoare, P. & Russell, M. (1995). The quality of life of children with chronic epilepsy and their families: Preliminary findings with a new assessment measure. Developmental Medicine & Child Neurology, 37(8), 689–696.

Thome-Souza, S., Kuczynski, E., Assumpção, F., Rzezak, P., Fuentes, D., Fiore, L., & Valente, K. D. (2004). Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy? Epilepsy & Behavior, 5(6), 988-994. doi: 10.1016/j.yebeh.2004.09.001

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