tag:blogger.com,1999:blog-77237737724998624992024-03-16T08:53:11.851-10:00Psychological MusingsDeborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.comBlogger391125tag:blogger.com,1999:blog-7723773772499862499.post-77445817226719759202017-06-04T12:13:00.005-10:002017-06-04T12:13:44.072-10:00Depression and Chronic and Autoimmune Disease<!--[if gte mso 9]><xml>
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<![endif]--><b>Depression and Chronic and Autoimmune Diseases </b> </div>
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Depression has a powerful affect on the immune and inflammatory response systems. It increases cortisol and other inflammatory cytokines such as IL-6, and an enzyme called IDO (Müller & Schwarz, 2007). These substances decrease the body's ability to heal, which can increase vulnerability to autoimmune diseases such as systemic lupus erythematosus (SLE). The goal of this paper is to describe the association between depression and SLE, explain the factors of the disease that account for its high co-occurrence with depression, and discuss the role of stress hormones and inflammation in SLE. Further, it will explain three teaching strategies that might reduce the effects of SLE and effective methods to encourage the adoption of strategies to reduce the effects of SLE.<br />
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<b>Depression and Systemic Lupus Erythematosus </b></div>
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High levels of inflammatory factors and depression are characteristic of many autoimmune diseases (Laureate Education, Inc., 2012). For example, depression is highly comorbid with systemic lupus erythematosus (SLE). More than 65% of patients with chronic rheumatological disorders, such as SLE suffer from depression (Maes et al., 2011). Patients with SLE have several comorbidities including hypertension, gall bladder disorders, cataracts, cardiovascular disease, and neurologic and endocrine disorders (Wolfe et al., 2010). Almost 40% of patients with SLE are diagnosed with depression, which, has been linked to a lower life quality (Wolfe et al., 2010). Palagini et al., (2013) claimed SLE is co-occuring with depression in 14% to 89% of patients. Women with SLE have at least a 47% chance of being diagnosed with depression. Further, anxiety and depression have been associated to permanent deformation of the joints and active inflammation in SLE patients (Waheed, Hameed, Khan, Syed, & Mirza, 2006). Depression is, however, the most prevalent comorbidity associated with SLE (Wekking, 1993). <br />
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<b>The Role of Stress Hormones and Inflammation in SLE </b></div>
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Depression associated with SLE may be mediated by an autoimmune mechanism (Palagini et al., 2013). Bachen, Chesney, and Criswell (2009) hypothesized proinflammatory cytokines play a role in SLE's inflammatory response. The body's cytokine immune response has been implicated in depression as well as in some autoimmune diseases (Wilson & Warise, 2008). Cytokines are immune proteins that regulate the immune system, especially during a stress response (Wilson & Warise, 2008). Cytokines, have an inflammatory effect on the neurotransmission of serotonin, a neurotransmitter that has been known to have a profound effect on psychological health and well-being (Dabhar, 2011; Salih & Feyza, 2012; Wilson & Warise, 2008). <br />
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SLE and other chronic inflammatory diseases are associated with depression (Wilson & Warise, 2008). It is well known that stress exacerbates symptoms of SLE (Peralta-Ramirez, Jimenez-Alonso, Godoy-Garcia, & Perez-Garcia, 2004). Further, cytokine imbalances are characteristic of autoimmune diseases, such as SLE, especially during its beginning stages as well as during disease progression (Freiri, 2003). When an excess of cytokines are flushed into the blood stream during stress, an enzyme called IDO is activated, and this enzyme degrades serotonin (Müller & Schwarz, 2007). This inflammatory process degrades the body's serotonergic system, which decreases the body's ability to manufacture serotonin. The lowered level of serotonin leaves the individual more susceptible to depression. <br />
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Maes (2010) found depression shares the same inflammatory pathways with other diseases, and rather than the existence of two separate degenerative processes, for example, one for SLE, and one for depression, these comorbidities may be symptoms of one degenerative process. Inflammatory processes may have a variety of causes, such as diet, lifestyle, and genetic predispositions, but the biological process may be singular (Maes, 2010). In addition, Maes (2010) found that this shared biological process is bidirectional, and cyclical, in that inflammation provoked degeneration and vice versa. <br />
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<b>Teaching Strategies to Reduce Anxiety</b></div>
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<b>Cognitive-Behavioral Stress Management </b></div>
Cognitive-behavioral stress management (CBSM) has been proven effective in ameliorating stress that accompanies chronic illness and has been shown to help individuals cope effectively with disease-related treatment and manage social resources (Nezu, Nezu, & Xanthopoulos, 2011). CBSM increased individuals' ability to find benefit in their illness as well as their ability to remain optimistic amid the challenge of chronic disease (Nezu et al., 2011). Stress and anxiety are common in SLE patients, and in general, they are not as aware of effective coping strategies as the general population, and the strategies they tend to use are inadequate and less effective than other strategies such as CBSM (Peralta-Ramirez et al., 2004). Patients who implemented CBSM perceived themselves less likely to have a flare of symptoms, felt confident about their future, experienced significant improvement in their psychological health and well-being, felt more vital, and experienced significantly less pain (Peralta-Ramirez et al., 2004). <br />
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<b>Exercise </b><br />
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Exercise has been shown to be a possible antidepressant and it exercise also generates neurons in adults (National Institute on Mental Health, 2010). Home-based exercise made a significant difference in a group of sedentary women with SLE (Yuen et al., 2013). Physical exercise was proven useful and successful in improving symptoms of SLE without provoking disease activity (Reis-Neto, Silva, Monteiro, Camargo, & Sato, 2013). Similarly, Ayán and Martín (2007) concluded SLE patients can benefit from exercise. <br />
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<b>Relaxation Techniques </b><br />
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Smith and Balaban (1983) found behavioral therapy that included deep relaxation, hypnosis and psychodynamic psychotherapy was effective for pain management, coping, and negative emotions associated with the stress of SLE. Torem (2007) postulated the immune system interacts with the central nervous system, and believed hypnosis and imagery could affect the immune system. Torem found this treatment effective in patients with autoimmune diseases. Zhang, Wei, and Wang (2013) discovered psychological interventions had the potential to help patients with SLE manage negative emotions and reduce stress. <br />
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<b>Encouraging Health Behavior Change </b><br />
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Changing health behaviors is a complex undertaking, and effective interventions must consider the individual (Glanz, Rimer, & Viswanath, 2008). The Transtheoretical Model (TTM) of behavior change is concerned with individually tailored interventions (Brug, 2004). When encouraging behavior change, it seems important to account for various individual factors in patients, especially their stage of understanding and their readiness for education. The TTM takes into account patients' attitudes and beliefs, which will have an effect on whether they can make changes in their health behavior (Glanz et al., 2008). Because this model of behavior change accommodates individual needs, it may be a salient component in developing effective interventions (Velicer, Redding, Sun, & Prochaska, 2007). This may be especially true in patients with SLE because this population has fewer effective stress management strategies than the general population (Peralta-Ramirez et al., 2004). Lack of awareness, education, and experience, may contribute to this deficiency, and understanding their personal experience and readiness may be important in establishing durable behavior change. <br />
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<b>Conclusion </b></div>
Depression is commonly found in a significant number of individuals diagnosed with SLE. The body's inflammatory immune response to stress has been implicated in depression and autoimmune diseases, such as SLE (Wilson & Warise, 2008). In particular, proinflammatory cytokines play a role in depression as well as in SLE's inflammatory response (Bachen, Chesney, & Criswell, 2009). Maes (2010) hypothesized that depression and illnesses such as SLE may share inflammatory pathways and a foundational cause. Since lifestyle and stress have the potential to cause inflammation, exercise, CBSM, and relaxation techniques may provide relief and decrease symptoms of depression and SLE (Zhang, Wei, & Wang, 2012). Utilizing the TTM, effective coping and stress management strategies that account for personal readiness can be developed for positive health outcomes and to instigate durable behavior change (Glanz et al., 2008). <br />
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Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-51278619862186044012014-07-13T11:14:00.002-10:002014-07-13T11:16:28.800-10:00Critical Thinking and Objectivity<!--[if gte mso 9]><xml>
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<div class="APA" style="line-height: 150%;">
The scientific method and critical
thinking offer some level of objectivity, and as Browne and Keeley (2013) described,
the systematic evaluation that is critical thinking, has the potential to
produce applicable and useable results.<span style="mso-spacerun: yes;"> </span>Researchers may be no more aware
of the gate keeping provided by critical thinking than they are of their own
biases.<span style="mso-spacerun: yes;"> </span>Critical thinking can
potentially help individuals question their own thoughts and understand
personal biases, which may be an important step in becoming more aware of when
these biases intrude and how to more effectively curtail their ability to skew
information (Innes & Fraser, 1971). </div>
<div class="APA" style="line-height: 150%;">
<br /></div>
<div class="APA" style="line-height: 150%;">
Browne, M. N., & Keeley, S. M.
(2013). <i>Asking the right questions: A guide to critical thinking</i> 9/e
(Custom Edition). Upper Saddle River, NJ: Pearson Prentice Hall.</div>
<div class="APA" style="line-height: 150%;">
<br /></div>
<div class="APA" style="line-height: 150%;">
Innes, J. M., & Fraser, C. (1971).
Experimenter bias and other possible biases in psychological research. <i>European
Journal Of Social Psychology</i>, <i>1</i>(3), 297-310.</div>
<div class="APA" style="line-height: 150%;">
<br /></div>
Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-32299636660051716182014-07-13T11:13:00.004-10:002014-07-13T11:16:10.472-10:00The Importance of Critical Thinking<!--[if gte mso 9]><xml>
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<br />
Critical thinking is crucial to the evolution of knowledge; it raises vital questions that contribute to the ongoing transformation and expansion of the knowledge base. Without the ability to react with systematic evaluation, the psychological sciences, and all sciences, for that matter, would not be able to produce accurate and reliable information, and would be subject to common conjecture and radically varying opinion (Brown & Keeley, 2013). Critical thinking minimizes the shortcomings of human thinking, such as egocentrism and sociocentrism. It requires thinkers to remain open-minded and skeptical simultaneously, and enables the development of lucid strategies for questioning, observing, and resolving ambiguities. It is a self-corrective thinking process, in which the thinker has the capacity to question his or her own thoughts. Critical thinking limits biased, simplistic, and rigid thinking. <br />
<br />
It is important to consider the limitations of information, even that which is scientifically gained; whether it is the diversity or number of participants, the length and location of the study, as well as the manner in which comparisons were made. Even the most conscientiously derived information is gained, at least in part, through processes supported by human nature, which has its inherent limitations. For example, when faced with ambiguities, humans naturally impose their personal perspectives to resolve to the ambiguity ( Brown & Keeley, 2013; Stewart & Bennett, 2006). For scientists, this process of imposition may be so deeply held that it becomes an unconscious bias and an inaccuracy that is difficult to recognize. <br />
<br />
In the psychological sciences, as well as for any final or capstone project, utilizing a critical thought process helps ensure a quality standard and objectivity, and prevents bias. Asking the most appropriate questions can act as a grounding force in psychological research, and encourages researchers to make accurate and intelligent statements and realistic and reasonable predictions (Browne & Keeley, 2013). Since research from the psychological professions serves humanity in a variety of ways, and is often the basis of care, treatments, and interventions, the standards and quality of that research must be the most accurate and reliable possible. If a researcher does not question the information itself, and the sources from which it comes, it is likely the final product may be flimsy, illusory, or merely superficial, and without merit where it is needed. <br />
<br />
Browne, M. N., & Keeley, S. M. (2013). Asking the right questions: A guide to critical thinking 9/e (Custom Edition). Upper Saddle River, NJ: Pearson Prentice Hall. <br />
<br />
Stewart, E. C., & Bennett, M. J. (2006). American cultural patterns: a cross-cultural perspective. Yarmouth, ME: Intercultural Press. <br />
<br />Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-15661979729291250182014-07-13T10:14:00.001-10:002015-05-18T22:13:19.722-10:00The Chicken and the Egg<!--[if gte mso 9]><xml>
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I was thinking about the chicken and egg
conundrum, and how it relates to the discussion of whether illness comes before depression or vice versa, and I wondered if possibly inflammation comes first.<span style="mso-spacerun: yes;"> </span>Medical science tells us that inflammation is the root of most,
perhaps all disease.<span style="mso-spacerun: yes;"> </span>To add to this
idea, I reviewed Filakovic, Bijan, and Petek (2008), which found similar elevated
levels of pro inflammatory cytokines in depression and psoriasis.<span style="mso-spacerun: yes;"> </span>These authors believed the basis of both
disorders was shared inflammatory pathways mediated by the immune system.<span style="mso-spacerun: yes;"> </span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
Similarly, Potter and Steffans (2007) found
depression was commonly diagnosed in individuals with mild cognitive
impairment, which may lead to Alzheimer's Disease (AD).<span style="mso-spacerun: yes;"> </span>Maes et al., (2010) found depression was an
antecedent to AD.<span style="mso-spacerun: yes;"> </span>The similarity is in
the Maes et al. explanation that depression and neurodegenerative diseases, such
as AD are the result of inflammation that is basically part of the same
biological process, along the same inflammatory pathways.<span style="mso-spacerun: yes;"> </span>Maes et al. believed the degeneration of
inflammatory pathways created a cycle in which neuroinflammation provoked
neurodegeneration and created a process by which depression exacerbated the
comorbidity, and vice versa.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
This idea of disease-sharing pathways was fascinating
to me.<span style="mso-spacerun: yes;"> </span>I wonder if
comorbidities are not independent occurrences, but rather are two symptoms of
the same process, it seems we will have to rethink the idea of comorbidities,
such as anxiety and depression (Hirschfeld, 2001).<span style="mso-spacerun: yes;"> </span>Rather than treating two diseases or
comorbidities, perhaps they will be treated as one degenerative process. </div>
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<br /></div>
<div class="MsoNormal">
Filakovic, P., Bijan, D., & Petek, A. (2008). Depression
in dermatology: An integrative perspective. <i>Psychiatria Danubina</i>, <i>20</i>(3),
419-425.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Hirschfeld, R. (2001). The comorbidity of major depression
and anxiety disorders: recognition and management in primary care. <i>Primary
Care Companion To The Journal Of Clinical Psychiatry</i>, <i>3</i>(6), 244-254.</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
Maes, M. (2010). An intriguing and hitherto
unexplained co-occurrence: Depression and chronic fatigue syndrome are
manifestations of shared inflammatory, oxidative and nitrosative (IO&NS)
pathways. <i>Progress in Neuro-Psychopharmacology and Biological Psychiatry</i>.
doi: 10.1016/j.pnpbp.2010.06.023</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
Potter, G. G., & Steffens, D. C. (2007).
Contribution of Depression to Cognitive Impairment and Dementia in Older
Adults. <i>The Neurologist</i>, <i>13</i>(3), 105-117. doi:
10.1097/01.nrl.0000252947.15389.a9<span style="line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt;"></span></div>
Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-13108450149464467012014-07-13T10:07:00.002-10:002014-07-13T10:07:50.642-10:00Proactive Approaches to Relieving Stress<!--[if gte mso 9]><xml>
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<![endif]--><br />It is interesting to think about proactive approaches to relieving stress, especially since our society, seems stress-provoking for many, perhaps most individuals. If social context, specifically having a social support system, is as important as many theoretical models propose, learning the benefits of social support as well as how to make the best use of it, seems an important part of intervening in populations who suffer the throes of isolation. An overwhelming amount of research suggests social support predisposes individuals to the most positive outcomes in a wide variety of circumstances (Jason, Witter, & Torres-Harding, 2003; Pakenham & Bursnall, 2006; Schroevers, Helgeson, Sanderman, & Ranchor, 2010). Of course, it would be important to identify cultural and other affects such as biological and neurological circumstances that preclude an individual from utilizing, or even understanding the benefits of social support systems. <br /><br /> Jason, L., Witter, E., & Torres-Harding, S. (2003). Chronic fatigue syndrome, coping, optimism and social support. Journal Of Mental Health, 12(2), 109-118. <br /><br />Pakenham, K. I., & Bursnall, S. (2006). Relations between social support, appraisal and coping and both positive and negative outcomes for children of a parent with multiple sclerosis and comparisons with children of healthy parents. Clinical Rehabilitation, 20(8), 709-723. doi:10.1191/0269215506cre976oa <br /><br />Schroevers, M. J., Helgeson, V. S., Sanderman, R., & Ranchor, A. V. (2010). Type of social support matters for prediction of posttraumatic growth among cancer survivors. Psycho-Oncology, 19(1), 46-53. doi:10.1002/pon.1501Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-59446758378156779472014-07-13T10:05:00.001-10:002014-07-13T10:05:17.755-10:00Mothers of Developmentally Disabled Children<!--[if gte mso 9]><xml>
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<![endif]--><br />I find it interesting that 35% of mothers parenting children with developmental disabilities experience intense isolation (Gupta, 2007). Even if the isolation is only perceived, the effects are tremendous and have the potential to cause chronic stress and a plethora of deleterious effects. I also found it compelling that 65% of this population did not experience the isolation and negative effects of parenting children with developmental disabilities. One longitudinal study found no difference in the well being of parents raising children with intellectual disabilities, and that many parents maintain positive perceptions of raising children with developmental disabilities (Mailick Seltzer, Greenberg, Floyd, Pettee, & Hong, 2001). Because of the discrepancy in the experiences of these parents, it seems important to identify the underlying issues that may exist. For example, if lower socioeconomic status exacerbates the experiences of isolation, it would be important to determine what types of interventions may ameliorate these social effects in this particular segment of the population. <br /><br />As always, when vastly different experiences are reported within a population, it becomes salient to examine the foundational influences. It seems to me that targeting these basic underlying factors may have the potential to produce a beneficial effect on the 35%. <br /><br />References <br /><br />Gupta, V. (2007). Comparison of parenting stress in different developmental disabilities. Journal Of Developmental & Physical Disabilities, 19(4), 417-425. doi:10.1007/s10882-007-9060-x <br /><br />Mailick Seltzer, M., Greenberg, J. S., Floyd, F. J., Pettee, Y., & Hong, J. (2001). Life Course Impacts of Parenting a Child With a Disability. American Journal on Mental Retardation, 106(3), 265. doi: 10.1352/0895-8017(2001)1062.0.CO;2Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-56572969415082987462014-07-13T10:01:00.000-10:002014-07-13T10:01:02.580-10:00More on Childhood Cancer<!--[if gte mso 9]><xml>
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<![endif]--><br />The psychological impact of isolation and separation are a critical part of the psychosocial effects of childhood cancer. Isolation and separation create a chronic stress, which has a definitive impact on the immune system as well as on the individual's psyche (Dhabar, 2011). I think these factors speak to the critical nature of providing these children with psychological support that includes friends and perhaps other children with cancer. <br /><br /> Excessive stress during childhood causes a dysregulation of leukocyes, which has the potential to add to the burden already placed on the immune system for children with cancer (Katz, Sprang, & Cooke, 2012). In healthy individuals, chronic stress can lead to increased mortality later in life as well as decreased cognitive functioning (Seeman, McEwen, Rowe, & Singer, 2001). This would place an additional tremendous burden on survivors of childhood cancer. <br /><br /> Because children tend to live in their own little worlds, it seems important to provide interventions that help them organize their world that suddenly includes cancer, which must be difficult for them to understand. This lack of understanding would likely contribute to the child's evaluation of their disease. Lazarus (1991) believed an experience is only as difficult or challenging as an individual evaluates it to be. Perhaps helping children to alter their perceptions - how they perceived their diagnosis would help them develop a more healthy emotional response. Lazarus found how individuals manage their emotional responses has a powerful effect on how they manage stress. The development of these skills seems critical for children with cancer and for survivors of childhood cancer. <br /><br /> References<br /><br />Dhabhar, F. S. (2011). Effects of stress on immune function: Implications for immunoprotection <br />and immunopathology. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: <br />Biology, psychology, and health (pp. 47–63). New York, NY: Springer Publishing Company. <br /><br /> Katz, D., Sprang, G., & Cooke, C. (2012). The cost of chronic stress in childhood: understanding and applying the concept of allostatic load. Psychodynamic Psychiatry, 40(3), 469-480. <br /><br /> Lazarus, R. S. (1991). Progress on a cognitive-motivational-relational theory of emotion. American Psychologist, 46(8), 819-834. doi:10.1037/0003-066X.46.8.819 <br /><br />Seeman, T. E., McEwen, B. S., Rowe, J. W., & Singer, B. H. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences of the United States of America, 98, 4770-4775. <br /><br /> <br /><br /> <br /><br /> <br /><br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-67475616312992595172014-07-13T09:50:00.001-10:002014-07-13T09:50:09.373-10:00Emotion and Problem-Focused Coping<!--[if gte mso 9]><xml>
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<![endif]-->Differences exist 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). <br /><br />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). <br /><br />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. <br /><br />References<br />
<br />
Baldacchino, D., & Draper, P. (2001). Spiritual coping strategies: A review of the nursing research literature. Journal of Advanced Nursing, 34, 833-841. <br /><br />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. <br /><br />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. <br /><br />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 <br /><br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-12141530652350513482014-07-13T09:40:00.003-10:002014-07-13T09:42:26.718-10:00Latino Youth in America<!--[if gte mso 9]><xml>
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Acculturative stress is the consequence of functioning within two cultural groups, which creates a dissonance because of the conflicting beliefs and attitudes within each group. Adolescents may be caught between two groups. For example, for Latino youth in America, stress may be the result of culture-related stress: acculturative stress, bicultural experiences, such as the difference between the adolescent's school and home life, and discrimination, all of which place the adolescent at a higher risk for substance abuse, domestic violence, and mental illness (Bridges, De Arelano, Rheingold, Danielson, & Silcott, 2010). In addition, the adolescent may struggle with participating within the American culture, which conflicts with his home life and his parents who want him to maintain their culture of origin and to maintain their cultural lifestyle, beliefs, and attitudes (Hays & Erford, 2010). <br />
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According to Lazarus (2006), stress is the result of the cognitive appraisal of a situation, and the extent to which the individual feels threatened and has the ability to influence the situation. Further, Lazarus (1991) believed the cognitive appraisal of a circumstance is a combination of mediating and moderating variables, which include the individual's cultural beliefs, attitudes, and lifestyle. For Latino youth, other variables may include low self-esteem, which can potentially alter the development of peer relationships, the inability to access resources, and facing discrimination. <br />
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<b> Stress Related Intervention </b><br />
Cultural sensitivity must be central in any intervention, but especially when culture-related stress is an issue. Interventions should be flexible and address cultural values that pertain to religion, family values, and identity development, which is different in Latino youth than in non-Latino white adolescents (Hays & Erford, 2010). For these reasons, Cultural Adaptation of Cognitive Behavioral Therapy (CBT) could be effective for this population. This intervention, like other forms of CBT teach how thoughts, activities, and interactions with other people, influence mood. It challenges negative thinking, and embraces the natural family support system, which is central in Latino culture (Duarté-Vélez, Bernal, & Bonilla, 2010). <br />
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<b>The Influences of Personal Bias </b><br />
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Cultural adaptation for an intervention should be developed in such a way that "increase(s) the congruence between the client's experience of a treatment and the properties of the treatment assumed by the therapist" (Duarté-Vélez et al., 2010, p. 896). Psychology professionals must be aware of the cultural values of the adolescent and his family, since family is a primary cultural value in Latino culture and maintaining emotional closeness to parents is a cultural ideal (Duarté-Vélez et al., 2010). Certainly, the Euro-centric aspects of psychology do not serve a broad segment of populations (Sue & Sue, 2008). It would be important for any professional working in culturally sensitive environments to acknowledge the effects of his or her personal views and realize that those views are not necessarily neutral. <br />
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References <br />
<br />
Bridges, A. J., de Arellano, M. A., Rheingold, A. A., Danielson, C., & Silcott, L. (2010). Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: Results from the Hispanic family study. Psychological Trauma: Theory, Research, Practice, And Policy, 2(1), 40-48. doi:10.1037/a0019021 <br />
<br />
Duarté-Vélez, Y., Bernal, G., & Bonilla, K. (2010). Culturally adapted cognitive-behavior therapy: integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino adolescent. Journal Of Clinical Psychology, 66(8), 895-906. <br />
<br />
Hays, D. G., & Erford, B. T. (2010). Developing multicultural counseling competence: A systems approach (Reprint ed.). Boston: Pearson. <br />
<br />
Lazarus, R. S. (1991). Progress on a cognitive-motivational-relational theory of emotion. American Psychologist, 46(8), 819-834. doi:10.1037/0003-066X.46.8.819 <br />
<br />
Lazarus, R. S. (2006). Emotions and interpersonal relationships: Toward a person-centered conceptualization of emotions and coping. Journal of Personality, 74(1), 9-46. doi: 10.1111/j.1467-6494.2005.00368.x <br />
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Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons. <br />
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<br />Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-68554818711378445202014-07-13T09:40:00.002-10:002014-07-13T09:43:03.646-10:00Eating Disorder Awareness<!--[if gte mso 9]><xml>
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<b> Abstract </b><br />
<br />
An awareness program for adolescent girls is developed and explored. The program educates adolescent girls and raises awareness of the prevalence and danger of eating disorders through interpersonal and interactive dialogues, formal and informal presentations and other media, small group discussions, and self-disclosure strategies. Eating disorders, their comorbidities and the confluence of factors that cause the initiation of these behaviors are presented and discussed. <br />
<br />
The program's purpose is to educate this population on body image, body dissatisfaction, the effects of societal pressure to be thin. Further, it addresses the influence of the media in promoting manufactured images that present women unrealistically, and the marketing of thinness as beauty. The program herein has been designed and implemented under the premise that the most effective instigator of positive change is knowledge. It is designed to explore the pervasive 'thin at all costs' movement that has created destructive operational definitions of female beauty. <br />
<br />
<b>Eating Disorder Awareness </b><br />
<br />
This program will focus on anorexia nervosa, bulimia nervosa, and binge eating disorder, which make up the eating disorders. Eating disorders are life-threatening illnesses (Herpetz et al., 2011), and they have the highest rate of death of all psychiatric disorders (Stice, Marti, & Rohde, 2013). The ten year mortality rate for people with anorexia nervosa is approximately 5%, which is ten times the mortality rate for other illnesses and disease. Over 10% of the population of young women meet the criteria for one or more eating disorders (Stice, Marti, & Rohde, 2013). Eating disorders are often accompanied by anxiety, distress, depression, suicidality, and unhealthy body weights (Stice et al., 2013). Creating awareness for girls during the initial year of high school is critical to raise awareness, that they can recognize the signs of eating disorders in themselves and in their friends, and become comfortable enough to engage in open discussions with each other as well as with their parents and other adults. <br />
<br />
The purpose of this paper is to create a comprehensive awareness program, describe its purpose, an appropriate setting for the program, and the projected time frame in which to implement the program. In addition, this paper discusses the target population and its health factors as well as its risk factors. Three goals for the program are described and five media and other elements that were added to the program are discussed. <br />
<br />
<b> Program Purpose </b><br />
<br />
The purpose of this program is to raise adolescent girls' awareness about eating disorders and body image issues, and the impact they have on girls, their families, and communities around the world. The program is driven by a theory that if adolescent girls learn about the life- threatening psychological and physiological effects of eating disorders, they are better prepared to arm themselves against the potential to develop such a disorder. The program has been developed to reduce the stigma that surrounds eating disorders, and to create access to information and treatment resources for adolescents with eating disorders and their families. The program was designed to provide age appropriate information, but demonstrate the fact that eating disorders are life-threatening illnesses - not a diet choice. It provides information and engages young women in discussions that promote the recognition of the pressures, cultural attitudes, and social behaviors that potentiate eating disorders. <br />
<br />
Body dissatisfaction in young women has become so pervasive, it is considered normal (Rodin, Silberstein, & Striegel-Moore, 1985). Further, this dissatisfaction, specifically the desire to be thinner, places a tremendous burden on the young woman, including lowered self-esteem and chronic excessive dieting (Dohnt & Tiggeman, 2005). This skewed self-perception is one of the most consistent predictors of eating disorders. According to the National Eating Disorders Association (2014), 42% of first- to third-grade girls want to lose weight, 81% of 10-year-olds fear becoming overweight, and 50 to 70% of normal-weight girls believe they are overweight. Two-thirds of girls in the 5th to 12th grades said that the images in magazines influence their idea of what their bodies should look like, and about half of this age group said the pictures made them believe they should lose weight. The internet, too, functions like magazines, promoting disordered eating and body dissatisfaction (Bair, Kelly, Serdar, & Mazzeo, 2012). Certainly the media has an influence on girls as they develop a healthy or unhealthy perspective about weight, body image, and healthy eating. <br />
<br />
<b> Health Topic: Eating Disorders </b><br />
<br />
Eating disorders have become commonplace in adolescent girls (Steinhausen, Gavez & Metzke, 2005). These disorders are potentially life threatening and cause short and long-term ramifications to individuals' psychological and physiological health. In the United States alone, over 30 million people will experience a clinically significant eating disorder at some point in their lives (Wade, Keski-Rahkonen, & Hudson, 2011). According to Stice (2002), central to the development of eating disorders is body dissatisfaction. It has been estimated that 80% of women in the United States are dissatisfied with their appearance. Forty to sixty percent of girls in elementary school, between the ages of 6 and 12 become obsessed with weight and express concern about being too fat (Smolak, 2011). <br />
<br />
<b> Awareness Program for Schools </b><br />
<br />
This program is designed to be implemented during the regular school day. The length of each session is 2.5 hours, with a fifteen minute break with snacks, halfway through the program. It is designed to be held once or more for each grade level, depending on the number of students, and will be held in the auditorium or another room that can hold at least 100 students at one time. During the first part of the program, the presenter will provide the participants with the facts and statistics along with the health risks and long-term effects of eating disorders. The adolescents will be shown a short video about the superficiality of image and how the media constructs images into a representation of women that is unrealistic and impossible to attain. An interactive discussion about body image and their experiences will follow. Another four minute video will be shown, after which there will be another interactive discussion. After the first hour, there will be a break after which the adolescents will break into smaller groups of 8-10 students. <br />
<br />
After the break, the smaller group sessions will begin. During this part of the program, the participants will be encouraged to express their experiences with disordered eating, the pressure they have experienced to be thin, and their personal body dissatisfaction, and other experiences pertaining to body weight, peer pressure and eating habits, and stress they experience because of the social pressure to be thin. <br />
<br />
<b> Targeting Adolescent Girls </b><br />
<b>Health Factors </b><br />
<br />
This program targets adolescent girls because this population experiences the greatest impact of eating disorders, which are developed during adolescence more than any other time in life (Steinhausen, Gavez, & Metzke, 2005; Stice et al., 2013). Forty-four percent of all female high school students are trying to lose weight. Even in fourth grade, one half of the girls are on a diet. In addition, the adolescent population is prone to risk-taking behaviors (Gardner & Steinberg, 2005; Steinberg, 2011; Roaten & Roaten, 2012). Brain changes that take place during adolescence have a profound impact on adolescents thoughts, feelings, and behaviors. For adolescent girls, this can mean dieting dangerously and utilizing starvation, binging and purging, and laxatives to prevent them from gaining weight. <br />
<br />
<b> Health Risks </b><br />
<br />
<b>Risk-Taking Behavior in Adolescents</b><br />
<br />
<b> </b>The adolescent brain changes dramatically, which effects the behaviors, emotions, and thoughts in the adolescent population (Gardner & Steinberg, 2005; Steinberg, 2011; Roaten & Roaten, 2012). These changes are partly the result of decreased synaptic connections, which compels this age group to seek new information, and contributes to adolescent risk-taking behavior (Roaten & Roaten, 2012). The pre-frontal cortex, which drives decision making, is one of the last parts of the brain to fully complete the reorganization process that enables adult decision making abilities (Gardner & Steingerg, 2005; Steinberg, 2011; Roaten & Roaten, 2012). As the pre-frontal cortex develops, the brain part most relied upon for decision making and managing challenges is the amygdala, which is partly responsible for the emotional outbursts and risk-taking behavior characteristic of this age group (Steinberg, 2011). Adolescent girls' undeveloped emotional processing system causes them to make emotional decisions and engage in dangerous behaviors, such as eating disorders, that they believe will help them be thin. <br />
<br />
<b>Health Risks in Anorexia Nervosa </b><br />
As a result of self-starvation, there is an increase in health risks for individuals with anorexia nervosa because the body slows its metabolism in an effort to conserve energy. Changes in the heart muscle, which increases the risk for heart failure, are evidenced by slowed heart rate and lowered blood pressure. Osteoporosis is the result of the body's lack of essential nutrients, when the body leaches minerals and nutrients from the bones, which is one of the last reserves of these elements in the body. When women initiate anorexic behavior in adolescence, they are far more prone to osteoporosis later in life compared to their healthy counterparts, even after several years of recovery from the eating disorder (Misra, 2008). In anorexia nervosa, especially, severe dehydration can cause kidney failure, and overall weakness and fatigue are chronic and constant symptoms of anorexia and the other eating disorders as well. Some evidence suggests women with a history of anorexia nervosa or bulimia nervosa experience a greater degree of infertility problems (How Eating Disorders Affect Fertility and Pregnancy, 2012). <br />
<br />
<b>Health Risks in Bulimia Nervosa </b><br />
<br />
There are two types of bulimia nervosa; the purging type, in which the individual uses self-induced vomiting, laxatives, diuretics, or enemas, and the non-purging type wherein the individual uses inappropriate compensatory behaviors, such as excessive exercise or fasting, but does not engage in self-induced vomiting, using laxatives, diuretics or enemas. The chronic use of binging and purging behavior can cause a variety of health problems including tooth decay, swollen gums or gum disease, osteoporosis, electrolyte imbalances, dehydration, and swollen salivary glands. In addition, bulimia nervosa has comorbidities including depression, substance abuse, social anxiety disorder, panic disorder, panic attacks, and borderline personality disorder. <br />
<br />
<b>Comorbidities with Eating Disorders </b><br />
<br />
Psychiatric and medical comorbidities are common in adolescent girls with eating disorders. Psychiatric disorders such as alcohol and substance abuse (Harrop & Marlatt, 2010), depression and mood disorders (Mangweth et al., 2003), and obsessive-compulsive disorder are most commonly reported (Altman & Shankman, 2009). In adolescents with bulimia nervosa, 25% had attempted suicide or inflicted self harm. Eating disorders have become more common with each passing year. These disorders represent a significant public health concern, not only because of the dramatic increase in the number of adolescents initiating disordered eating behaviors, but also because eating disorders are frequently comorbid with other psychopathologies and because the eating disorder becomes the primary concern, the comorbidities often go untreated or under-treated. <br />
<br />
<b> Program Goals </b><br />
<br />
<b>Creating Awareness </b><br />
<br />
The primary goal of this program is to create an awareness of the prevalence and danger of eating disorders through interpersonal dialogues, formal presentations, including Ted Talks, PowerPoint presentations, and other media, small group discussions, and self-reflection strategies. To increase ongoing awareness, the program will establish a network between the girls by having them share personal stories and experiences. The goal of the small group session is to break down the barriers between the girls by having them share universal feelings and experiences of body image and body dissatisfaction. In addition, it is hoped that they will feel less self-conscious about sharing personal experiences and these discussions will help them understand the importance of standing together rather than placing undue pressure on each other. Girls who experience greater levels of peer and parental pressure to be thin are more apt to initiate disordered eating behaviors (Huon & Walton, 1999). <br />
<br />
Establishing a stronger network between the girls has the potential to put them on the same side of the fight against the pressure to be thin and to utilize their newly established network as a personal strategy to increase self-esteem and to develop healthier interpersonal relationships with other young women. Sharing personal experiences will be encouraged fostered by encouraging discussions of personal experiences of the pressure to be thin and how they affect overall self-esteem and sense of self. <br />
<br />
<b>Bring Eating Disorders Out of the Closet </b><br />
<br />
A second goal of the program is to engage girls in open discussions about their experiences, fears, and concerns over eating disorders, and how they can help each other contend with and manage the pressure to be thin. This has the potential to create solidarity between the girls and help them recognize symptoms of the disorder and become more aware of each other's struggles. The small group portion of the program is designed so the girls feel comfortable enough to express their own struggles with thinness and eating. Especially during adolescence, girls have a powerful influence on each other in regards to body dissatisfaction and dieting (Dohnt & Tiggemann, 2005). <br />
<br />
This program will utilize peer influence since this age group is particularly susceptible to that influence (Gardner & Steinberg, 2005; Jaccard, Blanton, & Dodge, 2005; Thorlindsson & Bernburg, 2006). Because of the dramatic brain changes (and an increase in the number of mirror neurons in the adolescent brain), they are far more vulnerable to the vicarious experiences of their peers (Roaten & Roaten, 2012). The small group sessions are designed to promote openness and the expression of personal experiences that have the potential to deeply affect the girls. Adolescents, with their increased vulnerability to vicarious experience are sensitive to the emotions and struggles of their peers. Some research has found that teens can relate to protecting their friends more readily than they comprehend the need to protect themselves (Roaten & Roaten, 2012). <br />
<br />
<b>Create an Awareness of the Power of Media </b><br />
Societal pressure to be thin and the influence of the media in promoting eating disorders is a significant psychological burden among girls of this age group, and a primary contributing factor in body dissatisfaction and disturbed eating . The media is influential for women of all ages, and its power is insidious and often goes unrecognized, although its effects are evident (Ahern, Bennett, & Hetherington, 2008). It pressures girls intentionally, and perpetuates an ignorance and acceptance of unreasonable beauty and body expectations for girls and women. This program seeks to create an awareness of this silent crime against the female gender and educate girls on the marketing of thinness as beauty. <br />
<br />
Over the last three decades, models have gone from thin to severely underweight, and simultaneously the rate of eating disorders in young girls, young women, and women of all ages has continued to increase. Between 1980 and 1996, models weighed 8 percent less than average women. In 2008, they weighed 23 percent less than average women. Approximately 10% of Playboy centerfolds and 17% of beauty pageant participants have a body mass index that fits criteria for anorexia nervosa (Ahern et al., 2008). Today, the media is a commonly utilized information source for adolescent girls, and its influence is more powerful than it has previously been. Rather than retrieving information from friends and family, adolescents are bombarded with far more images that present women in unrealistic and unreasonable contrived female images (Ahern et al., 2008). <br />
<br />
Ahern and colleagues (2008) found that the real damage lies in the length of time and number of exposures to media that present women as underweight models. The more a girl is exposed to such models, the higher her desire is for thinness, which is, according to Ahern and colleagues (2008), "a cardinal symptom in eating disorders" (p. 305). After extended exposure to the contrived images of underweight models, girls believe the models are reflective of the real world. This program was designed in part to inform adolescent girls that the media presentations are not real world; they are contrived and heavily manufactured according to what the image is enticing the consumer to purchase. <br />
<br />
<b> Additions to PowerPoint Presentation </b><br />
<br />
<b>Poster-What You Weigh Shouldn't be Who You Are! </b><br />
The Theme for the program will be 'What you weigh shouldn't be who you are!' They will present the idea that eating disorders can destroy lives, and are destroying the lives of their friends or their sisters. The posters will be brief with graphics, and enough information (facts and statistics) to compel the girls to want to understand more about eating disorders. Posters will be placed on bulletin boards in hopes to stimulating discussion prior to the program. The posters will be geared to an adolescent's point of view and will be 'cool' rather than a traditional adult poster. It will be inviting, informative, and stimulating. <br />
<br />
<b>Handouts: Be a Voice, not an Echo! </b><br />
<br />
Patterned after the National Association of Anorexia Nervosa and Associated Disorders' 2014 National Eating Disorders Awareness Week, the handouts provided at the program will encourage the girls to maintain ongoing discussions about eating disorders between themselves, with their parents, or a healthcare professional. The handouts will encourage them to voice their personal strengths, talents, and standard of beauty, and to stop perpetuating media's unreasonable and unrealistic standards for beauty. They will promote ongoing discussions about eating disorders that will help girls get the help they need. The handouts will point out that keeping quiet about eating disorders gives more strength and influence to the current skewed standards of thinness and beauty. They will provide a list of resources for girls who want help but are afraid to talk about it. <br />
<br />
<b>Information Brochure for Parents </b><br />
<br />
A brochure will be provided for the girls who want to provide information for their parents. The theme of the brochure will be: It's time to talk about it. The girls will be encouraged to take the brochure home, but told that it is not necessary and they should only take the information if they want it. It is hoped that the brochure will raise awareness of eating disorders among parents. If parents can become more aware of the problems and pressures that adolescent girls face, it may encourage open discussions about eating disorders between adolescents and their parents. In addition, raising parents' awareness will provide them with the information they need to help their daughters or other adolescent girls struggling with weight issues, body dissatisfaction, and eating disorders. The brochure will be informative and factual, and will provide a list of resources for families struggling with a child with an eating disorder. <br />
<br />
<b>Dove Patches Video </b><br />
https://www.youtube.com/watch?v=EGDMXvdwN5c#aid=P-gscX4o03E <br />
<br />
The company that created Dove products created this video to show women that beauty is a state of mind rather than the fulfillment of unreasonable and unrealistic beauty standards. It is a four minute you tube video that was designed to help women discover how a change in perspective has the potential to incite a personal experience of beauty, the power of which lies within each person. The women in this video are invited to try a beauty patch that would help them to see themselves in a more beautiful light. They are instructed to wear it for two weeks and keep a diary on the changes they experience. The results were life-changing. After discussing the changes they experienced, the doctor explained the ingredients in the patch. There were none. It was a placebo that had a powerful effect on the way they perceived themselves. It is an enjoyable and empowering. <br />
<br />
<b>Ted Talks: </b><br />
<br />
https://www.ted.com/talks/cameron_russell_looks_aren_t_everything_believe_me_i_m_a_model <br />
<br />
This is a short, ten minute talk about the superficiality of physical beauty, the power of <br />
<br />
image, and how the media uses it to make women believe they should look a certain way. The speech is done by Cameron Russell, who has been a model for over ten years. She discusses the time and energy that goes into creating the images that are seen in magazines, on television, and that have become the basis of the cultural expectations and beauty standards for women. In addition, she helped the audience understand that the pictures seen in magazines and other media are not real women, they are contrived and manufactured images tailored to sell a product or enhance the written word. <br />
<br />
<b> Instigating Positive Change </b><br />
<br />
This program was designed and implemented under the premise that the most effective instigator of positive change is knowledge. When people understand an issue, they have the power to influence the course of its effects, and the effect it has on them, their community, and the world. This program will instigate positive change simply by presenting the prevalence, health risks, and factors that may instigate the initiation of disordered eating. In addition, it encourages this age group to establish new and more realistic expectations of body image and standards of beauty. <br />
<br />
The pervasive 'thin at all costs' movement has created a destructive definition of female beauty that is harming generations of young women, especially in Western culture. Although the United States has the highest rates of obesity, it also has the highest rates of eating disorders in the world. It is important to educate adolescent girls on the media, which is one of the most influencing factors in the creation of the images and beliefs held by this age group. Educating them on the creation of these images may help them more effectively differentiate between the construed and manufactured images from the pages of magazines, and images that are representative of real world bodies and beauty. <br />
<br />
Conclusion <br />
<br />
Eating disorders continue to increase, and the initiation of this behavior most commonly begins in adolescent girls. Eating disorders are complex, and their initiation is usually a confluence of factors, and no genetic reason has been identified to explain this behavior. It seems important to educate young women about the societal messages associated with body image, the unreasonable and ridiculous standards of beauty perpetuated by the media and the fashion industry, and the misconstrued and unfair values women place on themselves and other women. The program for adolescent girls described herein aims to raise awareness of eating disorders and explicate the confluence of social factors that contribute to body dissatisfaction and disordered eating. <br />
<br />
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<br />Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-16178559642896310602014-07-13T09:31:00.003-10:002014-07-13T09:31:29.038-10:00PTSD in Domestic Violence <!--[if gte mso 9]><xml>
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<![endif]--><br />For this discussion, I will focus on PTSD in children of domestic violence. Domestic violence exposes children to chronic violence that is not precipitated by anything definitive, and it usually not life threatening (Margolin & Vickerman, 2011). These two factors change the way psychologists think about PTSD in experiences of domestic violence, and the traumatic events that cause it. Domestic violence is one of the most commonly experienced adverse events during childhood, occurring in 30% of families with two parents (McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006). Half of all children exposed to domestic violence continue to experience intrusive thoughts, such as the re-experiencing of the violence, 20% experienced emotional numbing or avoidance, and 40% of one group experienced physiological hyperarousal (Rossman, Hughes, & Rosenberg, 2000). <br /><br />These children can be left feeling a sense of danger and uncertainty, and the effects of domestic violence can be similar in effect to severe child abuse (Huemer, Erhart, & Steiner, 2010). Children experiencing domestic violence are subjected to feelings of overwhelming fear and helplessness, which can be particularly intense when one parent is the aggressor. Additionally, they may develop disorganized attachment, since the aggressive parent is dangerous, yet the provider of safety Margolin & Vickerman, 2011). <br /><br />Complex traumas, such as domestic violence contribute to the inability to regulate anger and being self-destructive, affect their ability to pay attention, concentrate, and may cause learning difficulties. It affects self-confidence, self-esteem, and causes feelings of guilt and shame; causes aggression and substance abuse; creates trust and intimacy issues and creates challenges in interpersonal relationships (Margolin & Vickerman, 2011). <br /><br /><b> A Successful Intervention </b><br />Various forms of cognitive behavioral therapy, such as prolonged exposure therapy have been successful for children and adolescents with PTSD. Aderka and colleagues (2011) found that with prolonged exposure therapy, half of the children experienced sudden gains in their symptoms (Aderka et al., 2011). Prolonged exposure therapy combines behavioral and cognitive behavioral interventions that involve remembering traumatic events rather than avoiding thoughts associated with the trauma. Trauma-focused cognitive behavioral interventions were effective as was Stepped care trauma-focused cognitive behavioral therapy (Salloum, Scheeringa, Cohen, & Storch, 2014; Scheeringa, Weems, Cohen, Amaya‐Jackson, & Guthrie, 2011). Cognitive behavioral therapies may work for children similar to the way they work for adults by assisting them in reframing the traumatic events, learning to think about it from a different perspective, and break the cycles of negative thoughts that cause the re-experience of the trauma. This therapy might be effective in decreasing the replaying of the violence. Early interventions are more effective because "the lack of attention to the mental health of children and adolescents may lead to mental disorders with lifelong consequences,... and reduces the capacity of societies to be safe and productive" (World Health Organization, 2003, p. 2). <br /><br /><b> The Importance of Early Intervention </b><br />Early intervention can lessen the likelihood of continued symptoms of PTSD, and prevent further emotional and behavioral problems and poor psychological adjustment (Kenardy, Cobham, Nixon, McDermott, & March, 2010). In addition to decreasing further psychological damage, early interventions effectively reduce anxiety disorders and other symptoms associated with PTSD (Kenardy et al., 2010). It is important to recognize, however, that some adolescents recover on their own and an intervention will not be necessary or appropriate. <br /><br />References <br /><br />Aderka, I. M., Appelbaum-Namdar, E., Shafran, N., & Gilboa-Schechtman, E. (2011). Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 79(4), 441–446. <br /><br />Huemer, J. J., Erhart, F. F., & Steiner, H. H. (2010). Posttraumatic stress disorder in children and adolescents: A review of psychopharmacological treatment. Child Psychiatry and Human Development, 41(6), 624–640. <br /><br />Kenardy, J., Cobham, V., Nixon, R., McDermott, B., & March, S. (2010). Protocol for a randomised controlled trial of risk screening and early intervention comparing child- and family-focused cognitive-behavioural therapy for PTSD in children following accidental injury. BMC Psychiatry, 1092. doi:10.1186/1471-244X-10-92 <br /><br />Margolin, G., & Vickerman, K. A. (2011). Posttraumatic stress in children and adolescents exposed to family violence: I. Overview and issues. Couple and Family Psychology: Research and Practice, 1(S), 63–73. <br /><br />Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya‐Jackson, L., & Guthrie, D. (2011). Trauma‐focused cognitive‐behavioral therapy for posttraumatic stress disorder in three‐through six year‐old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860. Doi: 10.1111/j.1469-7610.2010.02354.x <br /><br />Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. Cognitive And Behavioral Practice, 2197-108. doi:10.1016/j.cbpra.2013.07.004 <br /><br />World Health Organization. (2003). Caring for children and adolescents with mental disorders: Setting WHO directions. Geneva, Switzerland: Author. Retrieved from http://www.who.int/mental_health/media/en/785.pdfDeborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-11824124227896985622014-07-13T09:19:00.001-10:002014-07-13T09:19:53.389-10:00Family Environment<br />The family environment has the potential for the greatest influence on a child. One challenge that must be considered when educating families is socioeconomic status. Families with less money to spend on food must consider price point and sadly, fresh fruits and vegetables and good quality meats are often more expensive than lower quality boxed and canned foods, or quick foods like chips and other snacks. <br /><br />Another challenge that should be considered is cultural effects, such as the predisposition to overweight and obesity. For example, obesity is prevalent here in the Hawaiian Islands. This is partly because of eating behaviors, but also because Native Hawaiians have a genetic predisposition to being overweight and obese (Brown, Gotshalk, Katzmarzyk & Allen, 2011). If I were to develop a program specific to this population, it would be prudent to consider this and other factors, such as Hawaiians use food as social communication. Further, Native Hawaiians, who make up only 10% of the Hawaiian population are subjected to constant discrimination, which has been linked to BMI (Antonio, 2010). These factors, among others, would be important to consider when developing a program to decrease weight in Hawaiian children or their families, emphasizing, once again, the complexity of developing weight loss programs. <br /><br />Brown, D. E., Gotshalk, L. A., Katzmarzyk, P. T., & Allen, L. (2011). Measures of adiposity in two cohorts of Hawaiian school children. Annals Of Human Biology, 38(4), 492-499. doi:10.3109/03014460.2011.560894 <br /><br />Antonio, M. K., & Mccubbin, L. D. (2012). Relationship Between Discrimination and Obesity Among Native Hawaiians. Washington, District of Columbia, US: American Psychological Association (APA). <br /><br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-67857887154373485802014-07-13T09:18:00.001-10:002014-07-13T09:18:11.140-10:00Influential Environments<!--[if gte mso 9]><xml>
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<![endif]--><span style="mso-tab-count: 1;"></span>My position is that both entities must shoulder the responsibility to create healthy diet and exercise environments for children, but the greater burden of responsibility rests on the parents. Proactive efforts made to address obesity in childhood should occur at multiple levels, including national advertising campaigns, community service announcements and programs, restaurant menus, school programs, family education, and the family's implementation of healthy choices in the home (Janicke, Sallinen, & Plume, 2008). I believe parents are the primary stake holders in their children's health, and the home environment has the potential to be an extremely negative (or positive) force in how children learn to eat and participate in healthy lifestyles. <br /><br /> Lifestyle and food consumption habits begin several years before the child enters school; and like many habits, eating routines start as early as birth (Lumeng, 2005). Lumeng (2005) found that the percentage of overweight children between the ages of 6 months and 2 years has increased from 7-12% between 1976 and 2000. The number of overweight children aged between the ages of 2-5 has doubled in the ten years between 1990 and 2000 (Lumeng, 2005). Children under the age of three, who are overweight do not have a greater chance of being overweight later in childhood than children at that age who are not overweight. However, when a child is overweight after the age of 3, they are 8 times more likely to be overweight in young adulthood than a 3 year old child of average weight. Satter (1992) describes the 'feeding relationship' that exists between a baby/child and the mother, and the quality of this relationship has a profound influence on the child's lifelong eating habits. <br /><br /><b> Strategies to Promote Diet and Exercise </b><br /><br /> Since obesity is a public health concern that poses problems for children and adults, especially for lower income families, I suggest a family education, such as the Expanded Food and Nutrition Education Program that emphasizes teaching families to make healthy food choices and reducing sedentary behaviors, since these lifestyle changes have been shown to reduce obesity. Educating parents, and involving them in children's weight reduction programs produces the best outcomes, especially when children are younger than 13 (Raynor, 2008). For children older than 13, however, involving the parent and child may be the most beneficial (Raynor, 2008). In any event, the education of parents is essential. Without their support, it may be difficult for children to maintain a change in diet. Family-based treatments for childhood obesity have been successful, and even simply limiting fast food consumption has made significant differences for families (Epstein, Valoski, Rena, & McCurley, 1994). <br /><br /> Schools should be held responsible for their part in influencing children and adolescents at school. Offering more time spent in physical education, and more health-related classes, and a drastic change in the lunch service program and changing the contents of vending machines accessed by students are all strategies that should be considered by school districts. <br /><br /> Children's behaviors are more likely to change when the consequences for their behaviors remain consistent across environments (Janicke, Sallinen & Plume, 2008). If schools and parents were reasonably similar in expectations related to diet and exercise, it is likely that children and adolescents would have a better chance of developing a healthy lifestyle and reducing their risk of overweight and obesity. This would take educated parents working in association with educated school systems, which would be a monumental undertaking. <br /><br />Epstein, L. H.,Valoski, A., Wing, R. R., & McCurley, J. (1994). Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology, 13(5), 373–3 83. <br /><br />Jelalian, E., & Hart, C. N. (2009). Pediatric obesity. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (4 ed., pp. 446–463). New York, NY: Guilford. <br /><br />Lumeng, J. (2005). What can we do to prevent childhood obesity? Zero to Three, 25(3), 13-19. <br /><br />Janicke, D. M., Sallinen, B. J., & Plume, J. C. W. (2008). <a href="https://class.waldenu.edu/bbcswebdav/institution/USW1/201450_01/PH_PSYC/PSYC_8573_PSYC_6573/readings/PSYC_8573_PSYC_6573_Week08_Janicke_Obesity_Prevention.pdf">Obesity prevention programs for school-aged children and adolescents</a>. In E. Jelalian & R. G. Steele (Eds.), Handbook of childhood and adolescent obesity (pp. 331–350). New York, NY: Springer. <br /><br />Raynor, H. A. (2008). <a href="https://class.waldenu.edu/bbcswebdav/institution/USW1/201450_01/PH_PSYC/PSYC_8573_PSYC_6573/readings/PSYC_8573_PSYC_6573_Week08_Raynor_Evidence_Based.pdf">Evidence-based treatments for childhood obesity</a>. In E. Jelalian & R. G. Steele (Eds.), Handbook of childhood and adolescent obesity (pp. 201–220). New York, NY: Springer. <br /><br />Satter, E. (1992). The feeding relationship. Zero to Three, 12(5), 1-9. <br /><br /><br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-11249156413207058482014-07-13T09:13:00.002-10:002014-07-13T09:13:59.527-10:00Public Health Prevention Programs<!--[if gte mso 9]><xml>
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Because obesity has become a significant health issue in many developed countries, public health prevention programs have begun to play a central role in preventing overweight and obesity in children and adolescents. The purpose of this assignment is to create a 30 second public service announcement for the local community to promote good nutrition for families. In addition, it will explain recent trends of poor diet and exercise in Hawaii, and explain how this program can reduce these trends. </div>
<br /><b> Health Promotion Campaign </b><br /> This health promotion campaign is designed to help Native Hawaiian Families with children and adolescents learn how to reduce their weight and be proactive against the illnesses that have become prevalent in this population. Neel (1962) hypothesized that some cultures, especially those that thrive in geographical isolation, develop a genotype that functions with a more energy efficient metabolism. Because Hawaii was geographically isolated for several hundred years, the Native Hawaiians may have developed this genotype. This, combined with the modernization (or Americanization) of their diets, creates a tendency toward overweight and obesity. Grandinetti and colleagues (1999) found when Native Hawaiians had a higher percentage of Hawaiian ancestry, they had an increased tendency for overweight and obesity that could not be explained by behavioral factors, such as their food intake or energy use. However, when Native Hawaiians were placed on a traditional (pre-Western contact) diets, they became healthier and lost significant amounts of weight (Shintani, Hughes, Beckam & O'Connor, 1991). <br /><br /><b> Recent Trends </b><br /><br /> During the last several decades, Native Hawaiians have experienced an increase in overweight and obesity-related diseases, such as kidney disease, insulin resistance, high blood pressure, and chronic diseases, such as diabetes, and various types of cancer (Aluli, 1991; Mau et al., 1997). In addition, their risk of death from chronic conditions is twice that of White Americans, and Native Hawaiians are diagnosed with chronic heart disease more than three times the rate of White Americans (U.S. Department of Health and Human Services, 2010). These statistics alone warrant a culturally sensitive health promotion program for diet and exercise. <br /><br /> Exacerbating the negative cultural health risks, negative self-perceptions in Native Hawaiian children are a result of cultural loss, which has traumatized the entirety of the race (Liu & Alameda, 2011). In addition, Native Hawaiians have the lowest incomes of all ethnicities living in the Hawaiian Islands (Mokuau & Matsuoka, 1005), and this, along with discrimination in the schools, and the poverty-ridden neighborhoods in which they typically live, contribute to the way Native Hawaiian children perceive themselves. Being overweight creates psychosocial challenges that contribute to negative self-perceptions (Liu, & Alameda, 2011). <br /><br /><b> Cultural Weight Loss Program</b> <br /><br /> The culturally sensitive weight loss program for Native Hawaiians will provide information and resources to assist them in learning about the benefits (including the economic benefit) of their traditional diet. Based on the premise that knowledge has the potential to instigate change, it will create an awareness of food consumption habits of Native Hawaiians as well as provide a foundational understanding of why the typical American diet has been a downfall in their health. <br /><br /> It will encourage parents to incorporate more ono (delicious) traditional Hawaiian foods and reduce the number of fast foods and snacks that have become a major component in the typical American diet. In addition, it will promote exercise, and encourage parents to involve their keiki (children) in sports and taking short walks in the evening. In sum, the program will help to create an awareness in the Hawaiian people, providing information on why the trends of overweight and obesity persist, even though they are not eating differently than their White counterparts. <br /><br /><b> Conclusion </b><br /><br /> Public health programs aimed at childhood obesity prevention should be age appropriate, and geared toward family involvement (Epstein, Valoski, Rena, & McCurley, 1994). In addition, programs must be culturally appropriate and consider local resources. Native Hawaiians need culturally sensitive information that will help them navigate the specific health issues unique to their population. This health program aims to provide a proactive approach specifically tailored for this indigenous population. <br /><br /> References <br /><br /> Aluli, N. E. (1991). Prevalence of obesity in a Native Hawaiian population. The American Society for Clinical Nutrition, Inc. Retrieved from http://ajcn.nutrition.org/content/53/6/1556S. <br /><br />Brown, D. E., Gotshalk, L. A., Katzmarzyk, P. T., & Allen, L. (2011). Measures of adiposity in two cohorts of Hawaiian school children. Annals Of Human Biology, 38(4), 492-499. doi:10.3109/03014460.2011.560894 <br /><br />Epstein, L. H.,Valoski, A., Wing, R. R., & McCurley, J. (1994). Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology, 13(5), 373– 383. <br /><br />Grandinetti, A., Chang, H., Chen, R., Fujimoto, W., Rodriguez, B., & Curb, J. (1999). Prevalence of overweight and central adiposity is associated with percentage of indigenous ancestry among native Hawaiians. International Journal Of Obesity And Related Metabolic Disorders: Journal Of The International Association For The Study Of Obesity, 23(7), 733-737. <br /><br />Liu, D., & Alameda, C. (2011). Social determinants of health for Native Hawaiian children and adolescents. Hawaii Medical Journal, 70(11 Suppl 2), 9-14. <br /><br />Mau, M. K., West, M. R., Shara, N. M., Efird, J. T., Alimineti, K., Saito, E., & ... Ng, R. (2007). Epidemiologic and clinical factors associated with Chronic Kidney Disease among Asian Americans and Native Hawaiians. Ethnicity & Health, 12(2), 111-127. doi:10.1080/13557850601081720 <br /><br />Neel, J. (1999). Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? 1962. Bulletin Of The World Health Organization, 77(8), 694-703. 362 <br /><br />Shintani, T., Hughes, C., Beckham, S., & O'Connor, H. (1991). Obesity and cardiovascular risk intervention through the ad libitum feeding of traditional Hawaiian diet. The American <br /><br /> Journal Of Clinical Nutrition, 53(6 Suppl), 1647S-1651S. <br /><br />U.S. Department of Health and Human Services. (2010). Heart disease and Native Hawaiians/Pacific Islanders. The Office of Minority Health. Retrieved April 15, 2013, from http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3 <br /><br /> <br /><br /> <br /><br /><br /> <br /> <br /><br /><br /> <br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-43372771869868839362014-07-13T09:12:00.001-10:002014-07-13T09:12:15.919-10:00Health Promotion Campaign<!--[if gte mso 9]><xml>
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<span style="mso-tab-count: 1;"></span>This health promotion campaign is designed to help Native Hawaiian Families with children and adolescents learn how to reduce their weight and be proactive against the illnesses that have become prevalent in this population. Neel (1962) hypothesized that some cultures, especially those that thrive in geographical isolation, develop a genotype that functions with a more energy efficient metabolism. Because Hawaii was geographically isolated for several hundred years, the Native Hawaiians may have developed this genotype. This, combined with the modernization (or Americanization) of their diets, creates a tendency toward overweight and obesity. Grandinetti and colleagues (1999) found when Native Hawaiians had a higher the percentage of Hawaiian ancestry, they had an increased tendency for overweight and obesity that could not be explained by behavioral factors, such as their food intake or their energy use (Gardinetti et al., 1999). However, when Native Hawaiians were placed on a traditional (pre-Western contact) diet, they became healthier and lost significant amounts of weight (Shintani, Hughes, Beckam & O'Connor, 1991). <br /><br /><b> Recent Trends </b><br /><br /> During the last several decades, Native Hawaiians have experienced an increase in overweight and obesity-related diseases, such as kidney disease, insulin resistance, high blood pressure, chronic diseases, such as diabetes, and cancers (Mau, Grandinetti, Arakaki, & Chang, 1997) (Aluli, 1991; Mau et al., 1997). In addition, their risk of death from chronic conditions is twice that of White Americans, and Native Hawaiians are diagnosed with chronic heart disease more than three times the rate of diagnosis of White Americans (U.S. Department of Health and Human Services, 2010). These statistics alone warrant a culturally sensitive health promotion program for diet and exercise. <br /><br /> Exacerbating the deleterious cultural health risks, negative self-perceptions in Native Hawaiian children are a result of cultural loss, which has traumatized the entirety of the race (Liu & Alameda, 2011). In addition, Native Hawaiians have the lowest incomes of all ethnicities living in the Hawaiian Islands (Mokuau & Matsuoka, 1005), and this, along with discrimination in the schools, and the poverty-ridden neighborhoods in which they typically live, contribute to the way Native Hawaiian children perceive themselves. Being overweight creates psychosocial challenges that contribute to self-perception. <br /><br /><b> Cultural Weight Loss Program </b><br /> The culturally sensitive weight loss program for Native Hawaiians will provide information and resources to assist them in learning about the benefits of their traditional diet. Based on the premise that knowledge has the potential to instigate change, it will create an awareness of food consumption habits of Native Hawaiians as well as provide a foundational understanding of why the typical American diet has been a downfall in their health. <br /><br />References <br /><br />Brown, D. E., Gotshalk, L. A., Katzmarzyk, P. T., & Allen, L. (2011). Measures of adiposity in two cohorts of Hawaiian school children. Annals Of Human Biology, 38(4), 492-499. doi:10.3109/03014460.2011.560894 <br /><br />Neel, J. (1999). Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? 1962. Bulletin Of The World Health Organization, 77(8), 694-703. 362 <br /><br />Grandinetti, A., Chang, H., Chen, R., Fujimoto, W., Rodriguez, B., & Curb, J. (1999). Prevalence of overweight and central adiposity is associated with percentage of indigenous ancestry among native Hawaiians. International Journal Of Obesity And Related Metabolic Disorders: Journal Of The International Association For The Study Of Obesity, 23(7), 733-737. <br /><br />Liu, D., & Alameda, C. (2011). Social determinants of health for Native Hawaiian children and adolescents. Hawaii Medical Journal, 70(11 Suppl 2), 9-14. <br /><br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-29238695069367769792014-07-13T09:10:00.002-10:002014-07-13T09:10:21.582-10:00Anxiety and Substance Abuse<!--[if gte mso 9]><xml>
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The self-medication hypothesis says that individuals in distress will utilize drugs and other substances to relieve the effects of their psychiatric disorder (Bovasso, 2001). However, some research has criticized the underestimation of the role of substance abuse in inducing anxiety and depression (Bovasso, 2001). Substance abuse and dependence precedes a variety of anxiety disorders, and was particularly significant in panic attack disorders, social phobias, and agoraphobia (Goodwin & Stein, 2013; Ham & Hope, 2003). On the other hand, in half of substance abuse cases, 40% of PTSD cases, and 30% of general anxiety disorder, the anxiety disorder began prior to the onset of substance abuse. <br /><br />Because of the co-morbid relationship between psychiatric disorders and substance abuse, establishing the sequence of onset may be an essential component of a successful intervention. This may be an especially salient issue in the discussion of anxiety in adolescents, because adolescent substance abuse has been linked to psychiatric disorders later in life (Bovasso, 2001). <br /><br />When substance abuse is co-morbid with anxiety, it is important to understand which disorder precedes the other, especially since treating the preceding disorder may prevent or reduce the risk of the secondary disorder (Robinson, Sareen, Cox, & Bolton, 2011). Other research has shown a common etiology, but in that case, too, treating the psychiatric disorder that appears first may reduce or prevent the risk of subsequent morbidity (Goodwin & Stein, 2013). <br /><br /><b> Self-Medication </b><br /><br />From a common sense standpoint, when an adolescent has frequent anxiety, she may have an opportunity to experiment with alcohol (for example). When she realizes how much better and more relaxed she feels after drinking, this would reinforce her desire to continue the drinking behavior. People tend to self-medicate when they are experiencing unpleasant symptoms and they believe, or learn from experience, that their choice of medication (in this case, alcohol) is the best way to resolve the problem of the unwanted symptoms (Piotrowski, 2013). Three things contribute to self-medication: access to the drug, understanding the dose and effects of the drug, and being part of a culture that encourages and accepts the use of the drug (Piotrowski, 2013). For adolescents, these criteria can be fulfilled easily. <br /><br />For adolescents with anxiety, self-medicating can lead to substance abuse, although it may alleviate their anxiety. Another consideration of adolescents self-medicating is that without being properly addressed by a mental health professional, the anxiety may increase over time, or eventually become exacerbated by the drug of choice. Self-medicating will provide short-term relief for anxiety, which makes it difficult for the adolescent to understand why this method of unsupervised treatment is unsafe and ultimately, ineffective. <br /><br /><b> Psychoeducation </b><br />Anxiety disorders are common during childhood and in adolescents. I believe psychoeducation is important for families with children or adolescents with anxiety and/or substance abuse issues. Especially when younger children suffer with anxiety, it would be important to intervene prior to the child nearing adolescence. When families are educated on anxiety and substance abuse, a better chance exists for early robust interventions that may decrease the typically subsequent morbidity (Goodwin & Stein, 2013). <br /><br />Bovasso, G. (2001). The Long-Term Treatment Outcomes of Depression and Anxiety Comorbid with Substance Abuse. Journal Of Behavioral Health Services & Research, 28(1), 42. <br /><br />Goodwin, R., & Stein, D. (2013). Anxiety disorders and drug dependence: evidence on sequence and specificity among adults. Psychiatry And Clinical Neurosciences, 67(3), 167-173. doi:10.1111/pcn.12030 <br /><br />Piotrowski, N. (2013). Self-medication. Magill’S Medical Guide (Online Edition), <br /><br />Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders. Archives of General Psychiatry, 68(8), 800–807. <br /><br />Ham, L. S., & Hope, D. A. (2003). Alcohol and anxiety: Subtle and obvious attributes of abuse in adults with social anxiety disorder and panic disorder. Depression & Anxiety (1091-4269), 18(3), 128-139. doi:10.1002/da.10130Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com1tag:blogger.com,1999:blog-7723773772499862499.post-46637329395157051192014-07-13T09:05:00.000-10:002014-07-13T09:05:04.875-10:00Sexually Transmitted Infections in High Schoo<!--[if gte mso 9]><xml>
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<![endif]-->Approximately 19 million people develop a new sexually transmitted infection (STI) each year. Men and women are equally susceptible and these infections affect people of various backgrounds and socio-economic levels. The goal of this paper is to describe my attached health promotion campaign that includes a poster directed at high school students. The poster is focused on the prevention of sexually transmitted infections. <br /><br /><b> Risk Factors </b><br /><br />Fifty percent of new infections in this country are among adolescents and young adults between the ages of 15 and 24. The health problems associated with STIs are far more serious in women than in men, and they can cause anogenital and cervical cancers, pelvic inflammatory disease, which can lead to infertility, and adverse pregnancy outcomes (Mansouri & Santos, 2013). In addition, when adolescents have one or more STIs, increases their likelihood of acquiring HIV and transmitting it to their sexual partners (Mansouri & Santos, 2013). <br /><br /><b> The Poster </b><br /><br /> The poster attached hereto is directed toward high school students, since they are the primary recipients of at least half of the newly acquired STIs. It is designed to be taken seriously, but with a bit of comic relief. In addition, it has been developed to grab their attention with color and the utilization of their 'language', such as the reference to 'No Love, No Glove'. These characteristics were intended to create a message that would be perceived as 'cool', and appropriate for their developmental stage. <br /><br /><b> School Interventions </b><br /><br />A large number of high school students are having sex, so the promotion of safe sex seems like an urgent topic for this age group. Rather than telling them not to have sex, reminding them (because they are already well aware of the consequences associated with unprotected and unsafe sex) to have safe sex seems like a more appropriate undertaking. Providing information within the school system has a variety of benefits for the prevention of STIs. School programs are an efficient and effective way to reach a large number of students, as well as the extended networks associated with the students, such as teachers, the students' families, and community members (World Health Organization (WHO), 1999). <br /><br /><b> Risk-Taking Behavior in Adolescents </b><br /><br />Adolescence is a time of intense developmental change when risk-taking behavior is common, and teenagers need guidance and accurate information to help them make informed and safe decisions (Jaccard, Blanton, & Dodge, 2005). According to U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services (USDOH) (2010), high school students have a tendency to engage in risk-taking behaviors that increase their chances of dying from the most common causes of death in for this age group. Peer pressure plays a central role in their decision making, and it is a force more powerful during adolescence than at any other time in a person's life (Jaccard, Blanton, & Dodge, 2005). This information, combined with the fact that 13.8% of students had sex with four or more partners and 34 - 47% were sexually active during high school (Mansouri & Santos, 2013; USDOH, 2010) emphasizes the need to promote safe sex during this developmental period. <br /><br />Research claimed that although sexual risk behaviors during adolescence have decreased, the rate of STIs in this population have increased (Claire Newbern, 2013). In addition to the risk factors associated with STIs, these infections render adolescents more susceptible to the exposure of HIV. Effective interventions designed to reduce STIs in high school students will also help this age group avert future STIs as well as HIV (Claire Newbern, 2013). Education is the most effective method for stopping the spread of STIs, and interventions that provide high school students with the knowledge they need to avoid becoming infected have been successful in schools (WHO, 1999). The attached poster was designed to remind students that the best way to prevent STIs (short of abstinence) is safe sex. Interventions that promote safe sex are proven to be more effective than the promotion of abstinence. <br /><br /><b> Conclusion </b><br /><br /> STIs are a serious public health threat to high school students. Because of the large number of sexually active adolescents and the added number of adolescents considering engaging in sex, it is imperative to ensure they understand safe sex, and have ample resources to implement their understanding. The school is an effective and efficient venue in which to provide effective interventions that will be meaningful in helping this age group avert STIs and the acquisition and transmission of HIV. <br /><br /> References <br /><br />Claire Newbern, E. E., Anschuetz, G. L., Eberhart, M. G., Salmon, M. E., Brady, K. A., De Los Reyes, A., & ... Schwarz, D. F. (2013). Adolescent Sexually Transmitted Infections and Risk for Subsequent HIV. American Journal Of Public Health, 103(10), 1874-1881. doi:10.2105/AJPH.2013.301463 <br /><br />Jaccard, J., Blanton, H. & Dodge, T. (2005). Peer influences on risk behavior: An analysis of the effects of a close friend. Developmental Psychology, 41(1), 135–147. <br /><br />Lang, D. L., Salazar, L.F., Crosby, R. A., DiClemente, R. J., Brown, L. K., & Donenberg, G. R. (2010). Neighborhood environment, sexual risk behaviors and acquisition of sexually transmitted infections among adolescents diagnosed with psychological disorders. American Journal of Community Psychology, 46(3–4), 303–311. <br /><br />Mansouri, R., & Santos, X. M. (2013). Sexually transmitted infections in adolescents. Contemporary OB/GYN, 58(4), 46-50. <br /><br />Seth, P., Patel, S. N., Sales, J. M., DiClemente, R. J., Wingood, G. M., & Rose, E. S. (2011). The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents. Psychology, Health & Medicine, 16(3), 346–356. <br /><br />U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services. (2010). Youth Risk Behavior Surveillance — United States, 2009, Surveillance Summaries, June 4, 2010. (CDC Publication No. SS-5. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf<br /><br />
World Health Organization (WHO). (1999). Preventing HIV/AIDS/STDs and related discrimination: An important responsibility of health-promoting schools. WHO Information Series on School Health – Document Six, (WHO/SCHOOL/98.6). Retrieved from http://www.who.int/entity/school_youth_health/media/en/90.pdf<br /><br />
World Health Organization. (2012). School health and youth health promotion: Facts. School and youth health. Retrieved from http://www.who.int/school_youth_health/facts/en/index.html <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br /><br /> Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-26938753842333842462014-07-13T09:00:00.002-10:002014-07-13T09:00:35.329-10:00Children's Role in Decision-Making<!--[if gte mso 9]><xml>
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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. <br /><br /> 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. <br /><br /><b> Family Strategies </b><br /><br />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. <br /><br />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. <br /><br />Piaget, J. & Inhelder, B. (1947) Diagnosis of mental operations and theory of the intelligence. American Journal of Mental Deficiency, 51(3), 401-406. <br /><br />Sachs, H., & Barrett, R. P. (1995). Seizure disorders: A review for school psychologists. School Psychology Review, 24(2), 131–145. <br /><br />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. <br /><br />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 <br /><br />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. <br /><br />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 <br /><br />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. <br /><br />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 <br /><br /> </div>
Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-29844130753715444562014-07-13T08:57:00.005-10:002014-07-13T08:57:51.988-10:00Migraine Headaches<!--[if gte mso 9]><xml>
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<![endif]--><span style="mso-tab-count: 1;"></span>Headaches are a common health problem in elementary schools, and are ranked as the fourth most common concern in that age group (Allen, Mathews, & Shriver, 1999; Özge et al., 2013), and are the most common neurological problem in adolescents (Marcelo et al., 2012; Özge et al., 2013). Migraine headaches are one of the two most common types in children and are characterized by a moderate to severe intensity of pain and are often accompanied by nausea and sensitivity to noise and light (Allen et al., 1999). Routine activity, such as school-related tasks aggravate the headache. Migraine headaches can be triggered by stress, such as demands originating at home or school, exercise, emotional distress, lack of good quality sleep, food allergies, food additives, diet, and hormonal imbalances (Mitchell et al., 2011). <br />
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<br /><b> Impacts on Adolescent's Educational Experience, Social Functioning, and Families </b><br /><br /> When children endure chronic headaches, they are more likely to develop emotional and behavioral problems if they do not have coping strategies effective for their age group (Allen et al., 1999). Additionally, adolescents who experience chronic headaches have an increased risk of developing depression, anxiety, and somatic pain. That said, most adolescents with chronic headaches show no significant psychological issues as a result of the headaches. In some children, however, chronic headaches can cause social withdrawal, impaired academic achievement because of increased school absences, and an lower threshold for stressors in the school environment (Allen et al., 1999). <br /><br /> Migraine sufferers have an unusually high degree of social anxiety (Marcelo et al., 2012). Kowal and Pritchard (1990) found that some, but not all, migraine sufferers were more shy and sensitive and experienced more frequent psychosomatic complaints. If migraines are a result of social anxiety, interventions that resolve underlying issues could be beneficial. Social anxiety often begins at 10-16 years of age and causes a range of social deficits in the academic environment, as well as in the development of social relationships (Marcelo et al., 2012). Adolescents with social anxiety are less likely to complete their education and have poor adjustment outcomes. When migraines begin in this age group, it is prudent to screen the adolescent for social anxiety (Marcelo et al., 2012). <br /><br /><b> Non-Medical Treatments </b><br /><br /> Adolescents can self-monitor their headaches as part of an assessment to determine the headache's triggers. For example, if an adolescent's headaches started after lunch on school days, it is reasonable to evaluate the adolescent's diet for food additives, various trigger foods, or food allergies. Allen, Mathews, & Shriver (1999) found a paucity of research on managing headache triggers, so families, school personnel, and even the adolescents themselves, must be creative when circumnavigating the foods or other triggers that appear to be causing the headaches. Once an adolescent understands the triggers he or she needs to avoid, they can self-manage with some help in finding alternatives to the problematic foods or other factors that are causing the migraines. Triggers other than foodstuffs may be underlying the migraines as well. When an adolescent keeps a diary for a few weeks, it is easier to identify the migraine's antecedents. <br /><br /> References</div>
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Allen, K. D., Mathews, J. R., & Shriver, M. D. (1999). Children and recurrent headaches: Assessment and treatment implications for school psychologists. School Psychology Review, 28(2), 266–279. <br /><br />Kowal, A. & Pritchard, D. W. (1990). Psychological characteristics of children who suffer from headache: A research note. Journal of Child Psychology and Psychiatry, 31(4), 637–649. <br /><br />Liakopoulou-Kairis, M., Alifieraki, T., Protagora, D., Korpa, T., Kondyli, K., Dimosthenous, E., & Kovanis, T. (2002). Recurrent abdominal pain and headache: Psychopathology, life events, and family functioning. European Child & Adolescent Psychiatry, 11(3), 115–122. <br /><br />Holden, E. W., Gladstein, J.U., Trulsen, M., & Wall, B. (1994). Chronic daily headache in children and adolescents. Headache: The Journal of Head and Face Pain, 34(9), 508–514. <br /><br />Masruha, M. R., Lin, J., Minett, T. C., Vitalle, M. S., Fisberg, M., Vilanova, L. P., & Peres, M. P. (2012). Social anxiety score is high in adolescents with chronic migraine. Pediatrics International, 54(3), 393-396. doi:10.1111/j.1442-200X.2011.03555.x <br /><br />Mitchell, N., Hewitt, C., Jayakody, S., Islam, M., Adamson, J., Watt, I., & Torgerson, D. (2011). Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutrition Journal, 1085. doi:10.1186/1475-2891-10-85 <br /><br />Özge, A. A., Sasmaz, T. T., Bugdayci, R. R., Çakmak, S. E., Kurt, A. Ö., Kaleagasi, S. H., & Siva, A. A. (2013). The prevalence of chronic and episodic migraine in children and adolescents. European Journal Of Neurology, 20(1), 95-101. doi:10.1111/j.1468-1331.2012.03795.x</div>
Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-64218161590408139252014-07-13T08:55:00.004-10:002014-07-13T08:55:38.979-10:00Conflicting Views on Adherence Conflicting views on adherence is likely an issue between parents and
adolescents with any type of chronic illness, seeing that even healthy
adolescents seem to thrive on views that are contrary to their parents'
perspectives. I imagine parents of CF are acutely aware of the tragic
outcome for their children. Although the adolescent may perceive it as
far off in an unimaginable future, the parents are likely well aware of
the shortened lifespan for their child. Poor treatment adherence is
associated with lower quality of life, disease progression and an
increase in infections that further deteriorate all of the above (Abbott
& Gee, 1998). Although there is a paucity of research on the
effects of non adherence and life expectancy (Abbott & Gee, 1998),
it may not be unreasonable to assume that non-adherence may lead to the
earlier demise of the patient. This alone would cause conflict between a
knowledgeable parent and a non-adhering adolescent. <br /><br />I can see
the importance of creating a dynamic in which the adolescent perceives
the parent on their side, rather than as a daunting rule maker. As you
mentioned, improving that relationship can increase treatment adherence.
Thanks for the interesting article. <br /><br />Abbott, J., & Gee, L.
(1998). Contemporary psychosocial issues in cystic fibrosis: Treatment
adherence and quality of life. Disability And Rehabilitation: An
International, Multidisciplinary Journal, 20(6-7), 262-271.
doi:10.3109/09638289809166737Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-38681784595507778532014-07-13T08:55:00.001-10:002014-07-13T08:55:12.156-10:00Cystic Fibrosis and its Effects on Quality of Life<!--[if gte mso 9]><xml>
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One of the most challenging symptoms of having cystic fibrosis CF is labored breathing because of mucus obstruction and opportunistic infections. CF has been characterized as a multisystem genetic disease that ranges in severity and affects the quality of life (QOL) in children and adolescents (Kianifar, Bakhshoodeh, Hebrani, & Behdani, 2013). In addition to lung function, it affects the reproductive organs and the pancreas, which can lead to CF- related diabetes (Kianifar et al., 2013). In addition to these biological challenges, older adolescents and adults have psychological burdens, such as concern about obtaining and maintaining a job, having a normal family life, and life expectancy (Kianifar et al., 2013). <br /><br />CF is the cause of significant emotional stress on patients and families (Hegarty, MacDonald, Watter, and Wilson, 2008). Daily health maintenance routines are time consuming, but necessary, and can interfere with maintaining a normal life. Treatments with medications, nutritional demands, and sufficient exercise can create demanding lifestyles, although such a lifestyle is necessary for health maintenance (Tibosch et al., 2011). There seems to be a paucity of research on the emotional QOL of children, and there is some disagreement between parents' perceptions and the perception of the child with CF, with parents rating emotional QOL lower than the children rate their own emotional QOL. <br /><br />In Laureate Education, Inc. (2012), Chelsey found it daunting to be told she had to be accountable for a number of tasks related to her CF. In addition, children and especially adolescents, face the challenges of self-management, identity development, intimacy, and family planning (Tibosch et al., 2011). Additionally, because of the increased awareness of the effects of infection, segregating children and adolescents with CF in schools has the potential to exacerbate stigma and social isolation (Quittner, Barker, Marciel, & Grimley, 2009), which may be well-developed in the CF population because of unusual and time-consuming daily routines (Tibosch et al., 2011). <br /><br /><b> Two Approaches to Enhance QOL </b><br /><br />Family dynamics play an important role in the lives of children, and meal time is an experience wherein family members have the opportunity to interact and communicate (Janicke, Mitchell, Quittner, Piazza-Waggoner, & Stark, 2008). Positive interactions at the dinner table have the potential to promote emotional health and facilitate a positive environment for eating and digestion (Janicke et al., 2008). These health factors are more important in families of children with CF, since they need to eat more than the average child. One such intervention, Be In Charge, encourages giving praise to appropriate behaviors and not giving attention to the disruptive or inappropriate behaviors (Janicke et al., 2008). In addition, the approach fosters setting goals and rewarding children for good work. This behavioral intervention teaches parents to be consistent with rules and expectations and fosters healthy family interactions at the dinner table. Further, this program improved adherence to special diets and was successful in increased weight gain (Janicke et al., 2008). Weight gain is a result of dietary adherence, which is an important part of the overall management of CF (Janicke, et al., 2008; Stark et al., 2003). Overall management of the disease would increase QOL. <br /><br />A second approach is a psychological intervention that utilizes social support to relieve maternal anxiety (Drotar, 2006). Pairing mothers of children with CF, diabetes, and asthma not only helped the parents cope, but it helped the children as well. Creating a family-to-family support network relieved stress and anxiety in mothers, and reduced anxiety and depression in the children. There is a paucity of research on this approach with families with CF, however, and further research is warranted (Drotar, 2006). <br /><br /> To maintain a good quality of life in children and adolescents with CF, families need to work with a team that includes pediatricians, pediatric psychologists, and social service workers. Although this approach is often ignored, it has been associated with positive health outcomes for children and adolescents with CF (Kianifar et al., 2013). <br /><br />References<br />
<br />
Drotar, D. (2006). Psychological Interventions: Cystic Fibrosis. In , Psychological interventions in childhood chronic illness (pp. 203-219). American Psychological Association. doi:10.1037/11412-010 <br /><br />
Quittner, A. L., Barker, D. H., Marciel, K. K., & Grimley, M. E. (2009). Cystic fibrosis: A model for drug discovery and patient care. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric p sychology (4th ed., pp. 271–286). New York, NY: Guilford. <br /><br />Hegarty, M., MacDonald, J., Watter, P., & Wilson, C. (2009). Quality of life in young people with cystic fibrosis: effects of hospitalization, age and gender, and differences in parent/child perceptions. Child: Care, Health & Development, 35(4), 462-468. doi:10.1111/j.1365-2214.2008.00900.x <br /><br />Janicke, D. M., Mitchell, M. J., Quittner, A. L., Piazza-Waggoner, C., & Stark, L. (2008). The impact of behavioral intervention on family interactions at mealtime in pediatric cystic fibrosis. Children’s Health Care, 37(1), 49–66. <br /><br />Kianifar, H., Bakhshoodeh, B., Hebrani, P., & Behdani, F. (2013). Quality of Life in Cystic Fibrosis Children. Iranian Journal Of Pediatrics, 23(2), 149-153. <br /><br />Laureate Education, Inc. (Executive Producer). (2012). Child and adolescent health: Living with cystic fibrosis. Baltimore, MD: Author. <br /><br />Stark, L. J., Bowen, A. M., Tyc, V. L., Evans, S., & Passero, M. A. (1990). A behavioral approach to increasing calorie consumption in children with cystic fibrosis. Journal of Pediatric Psychology, 15(3), 309–326. <br /><br />Tibosch, M., Sintnicolaas, C., Peters, J., Merkus, P., Yntema, J., Verhaak, C., & Vercoulen, J. (2011). How about your peers? Cystic fibrosis questionnaire data from healthy children and adolescents. BMC Pediatrics, 1186. doi:10.1186/1471-2431-11-86 <br /><br /> <br />
Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-1802266450064457682014-07-13T08:46:00.004-10:002014-07-13T08:46:51.374-10:00Reducing Noncompliance in Cystic Fibrosis<!--[if gte mso 9]><xml>
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<a href="https://www.blogger.com/null" name="bkFirstPageTitle"></a><span style="mso-tab-count: 1;"></span>It has been estimated that at least 30% of children with chronic diseases are noncompliant with their medication and other treatment requirements (Ou, Feldman, & Balkrishnan, 2010). Adherence in children and adolescents varies with age, and younger children are usually more adherent than adolescents, although Chelsey had a difficult time with her lifestyle changes after being diagnosed at age three. The purpose of this paper is to develop a behavioral intervention to improve Chelsey's compliance with her medical routines, and to describe a rewards system based on the behavioral intervention. Further, a justification for the use of the intervention will be explained. <br />
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<br /><b> Chelsey </b><br /><br /> Chelsey is a three-year-old girl with cystic fibrosis. She has developed a distinct sense of autonomy for a child her age. Chelsey was recently diagnosed with cystic fibrosis and does not like taking medications or participating in her twice daily vest treatments. The vest is large for her and she is uncomfortable with the vibrations. Although typically, younger children like Chelsey are more likely to adhere to treatments, she cries and becomes angry and defiant when it is time for her vest treatment. She takes her medicines with slightly less issue, although not without crying. Mealtimes are relatively calm, and her parents have utilized a behavioral intervention that has helped them provide Chelsey and her siblings with a calm mealtime experience that has been conducive to maintaining a sense of normalcy for the family while providing Chelsey with an adequate calorie intake. <br /><br /><b> Chelsey's Reward System </b><br /> Chelsey's reward system is based on operant conditioning, which utilizes positive reinforcement. This conditioning pairs the desired behavior with a reward or positive event, thereby increasing the likelihood that the behavior will occur again (Luersen et al., 2012). It is also based on Chelsey's love of all things princess-like. Chelsey's parents developed and utilize a system of behavior modification that provides her with award points when she follows her meal plans, including snacks, takes her medications without crying, and wears her treatment vest for 30 minutes each morning and evening. When Chelsey successfully completes one component of her routine: eating, snacking, or vest routine, she is awarded a crown or a princess on her Princess Chart. During her evening vest treatment, if she has earned enough stickers that day, she can exchange them for playing with her new princess dress-up box of garments, accessories, and crowns, which her parents have created specifically for this intervention. Chelsey is only allowed to play with the special box of princess finery during evening vest treatment time. <br /><br /><b> Justification </b><br /><br /> Positive reinforcement interventions for children with chronic diseases, such as cystic fibrosis have been associated with treatment adherence, which has the potential to improve health outcomes (Graves, Roberts, Rapoff, & Boyer, 2010; Luersen, & Feldman, 2011; Luersen et al., 2012). Sticker charts have been utilized to increase medication adherence with positive reinforcement (Ou et al., 2010). Chelsey's chart is straightforward, simple, colorful (in her favorite color) and its theme is based on her favorite interest, which is princesses. The aesthetic aspects of the chart are designed to engage her at her young age. One of the common reasons for poor adherence in younger children is getting them to sit still during treatment (Ou et al., 2010). The rewards system is designed to help Chelsey look forward to her vest treatment and provide her with a distraction while doing it. Stark and colleagues (2005) found sticker charts an easy and effective means of establishing treatment adherence in pediatric populations while improving patient health outcomes. <br /><br /><b> Conclusion </b><br /><br /> Although adolescents may have unique challenges to treatment adherence, young children have their own distinct difficulties sitting still long enough for treatments, and understanding why they must do it. Chelsey 's behavioral sticker chart, with its simplicity and attainable special rewards, helped her maintain compliance while she received the instant gratification of stickers, which were exchanged for a special reward at the end of each day during her evening treatment. Stark and colleagues (2012) provided evidence that utilizing the behavioral principles of positive reinforcement has the potential to increase treatment adherence in young children. The simple sticker program is a quick and easy-to-implement routine that can provide the patient and family with durable beneficial results. </div>
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References <br /><br />Graves, M. M., Roberts, M. C., Rapoff, M., & Boyer, A. (2010). The Efficacy of Adherence Interventions for Chronically Ill Children: A Meta-Analytic Review. Journal of Pediatric Psychology, 35(4), 368-382. doi: 10.1093/jpepsy/jsp072 <br /><br />Luersen, K. K., & Feldman, S. R. (2011). Increasing Treatment Compliance with Sticker Charts. Skin And Aging, 19(11), 42. <br /><br />Luersen, K., Davis, S. A., Kaplan, S. G., Abel, T. D., Winchester, W. W., & Feldman, S. R. (2012). Sticker Charts: A Method for Improving Adherence to Treatment of Chronic Diseases in Children. Pediatric Dermatology, 29(4), 403-408. doi:10.1111/j.1525-1470.2012.01741.x <br /><br />Ou, H., Feldman, S. R., & Balkrishnan, R. (2010). Understanding and Improving Treatment Adherence in Pediatric Patients. Seminars In Cutaneous Medicine And Surgery, (2), 137. doi:10.1016/j.sder.2010.03.012 <br /><br />Stark, L. J., Opipari, L. C., Jelalian, E., Powers, S. W., Janicke, D. M., Mulvihill, M. M., & Hovell, M. F. (2005). Child Behavior and Parent Management Strategies at Mealtimes in Families With a School-Age Child With Cystic Fibrosis. Health Psychology, 24(3), 274-280. doi:10.1037/0278-6133.24.3.274</div>
Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-74726830789274911582014-07-13T08:40:00.003-10:002014-07-13T08:40:50.657-10:00The Impact of Pediatric Cancer<!--[if gte mso 9]><xml>
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The experience of pediatric cancer has a myriad of consequences for patients and their families. Unfortunately there is a paucity of research on the psychological costs of a childhood cancer diagnosis, although the research that does exist provides a window into the often daunting sequelae that remains long after even successful cancer treatments have been completed. The purpose of this paper is to describe congenital retinoblastoma, and explain its signs, symptoms, treatment, and prognosis. In addition, it will explain how a pediatric cancer diagnosis and its treatment might impact the psychological, emotional, and behavioral functioning of children and adolescents and their families. <br /><br /><b> Congenital Retinoblastoma </b><br /><br /> Retinoblastoma is a rare and characteristically aggressive childhood cancer of the retina that is diagnosed in children younger than the age of 3 (Carter, 2009; Sacchetto, da Lustrosa & Miyuki, 2002). The retina is the layer of the eye that is sensitive to light and encodes and sends visual messages to the brain. Many of the processes of visual perception are produced as a result of this encoding and the processing of light into messages that can be interpreted by the brain into distinguishable images. Hence, the retina plays a central role in sight. <br /><br /> Retinoblastoma can occur in one eye or both eyes (Carter, 2009; Sacchetto, da Lustrosa & Miyuki, 2002). Its cause is a genetic defect and develops as a result of the rapid eye growth that takes place during the first few years of a child's life. Three hundred new cases of retinoblastoma develop each year in the United States, and one in 17,000 are affected. Forty percent of children with retinoblastoma have the congenital (hereditary) form of the disease, which places the child at a strongly increased risk for secondary cancers, and has been associated with excess mortality (Dommering et al., 2012). <br /><br /> The average age of a retinoblastoma diagnosis is eighteen months and is rarely found in children older than five (Sacchetto, da Lustrosa & Miyuki, 2002). For congenital retinoblastoma, children are usually diagnosed by age one. In congenital retinoblastoma, every cell in the body is missing one of the pair of retinoblastoma genes, which predisposes children to later cancers. This gene is a tumor suppressing gene that controls cell division. Without the normal pair of these genes, the body loses its ability to control cell division, and cells, specifically malignant cells can divide out of control. As a result, children with congenital retinoblastoma are likely to develop other cancers (Dommering et al., 2012). <br /><br /><b> Signs and Symptoms </b><br /> One of the more common signs of retinoblastoma is leukocoria, which presents as a white pupil (Carter, 2009). Rather than reflecting off the retina, leukocoria is caused by light reflecting off the tumor in the eye. Sometimes the growth of the tumor can cause changes to the surface of the iris, which causes a change in the iris' color, called heterochromia (Carter, 2009). A misalignment of the eyes, similar to crossed eyes or wandering eyes, can take place as the tumor grows and interferes with the child's eyesight. As the child's eyesight degrades, the brain can no longer hold the eyes in their natural alignment, which may cause one or both of the eyes to drift inward or outward. Initially, the eye and eyelids can become inflamed or protrude from the eye socket, resembling an infection (Carter, 2009). This is the body's immune system mounting a defense against the malignancy. Other symptoms can include poor vision, which can be difficult to diagnose in young children, and pain (Carter, 2009; Dommering et al., 2012). <br /><br /><b> Treatment </b><br /><br /> The treatment of retinoblastoma depends on the grade and stage of the tumor. The extent to which the tumor has invaded other areas of the eye, the lymph nodes, or other remote areas of the body determine the cancer's progression. With more progressed and invasive tumors, treatments are typically more complex over a longer period. Congenital retinoblastoma is a rare type of cancer that requires specialists for the unique needs and treatment options available. Usually general oncologists refer patients to major children's cancer centers that offer the best chance of recovery and preserving eyesight (American Cancer Society, 2014d). <br /><br /> Treatments include chemotherapy, cryotherapy, laser therapy, radiation, or enucleation, which is the removal of the eye (American Cancer Society, 2014d). When the disease has metastasized, doctor's may elect to treat the extensive cancer with stem cell transplantation (American Cancer Society, 2014e). Systemic chemotherapy is injected into a vein or given orally (American Cancer Society, 2014c). Periocular chemotherapy for advanced cancers are injected into the tissues surrounding the eye, and accomplished when the child is under general anesthetic. Intra-arterial chemotherapy is be injected directly into the ophthalmic artery, which supplies blood to the eye. This is usually done under general anesthesia every few weeks (American Cancer Society, 2014c). <br /><br /> Cryotherapy utilizes a small probe at freezing temperatures to kill the cancer cells by freezing them (American Cancer Society, 2014b). This type of therapy is most effective with small tumors at the front of the eye. It can cause damage to the retina and temporarily cause it to detach from the eyeball. Laser therapy utilizes infrared light to heat the tumor. It may be used in conjunction with chemotherapy or radiation therapy (American Cancer Society, 2014a). <br /><br /><b> Prognosis </b><br /><br /> Like the treatment options, which depend on the progression of the tumor, the prognosis for retinoblastoma depends on the grade and stage of the tumor as well. In congenital retinoblastoma, the gene mutation has an impact on immune functioning throughout the child's life, and has a prognosis of excessive mortality (Dommering et al., 2012). This cancer carries a less favorable prognosis since secondary cancers are common because of the genetic defect. Additional cancers return after an average of 10-13 years after the successful treatment of the initial cancer (Dommering et al., 2012). <br /><br /><b> Affects of Diagnosis on Children and Adolescents and Their Families </b><br /> When a child or adolescent is given a cancer diagnosis, parents experience psychological crisis, which is ordinarily more severe than the child or adolescent's reaction to the diagnosis, especially if the child is young (Greening, & Stoppelbein, 2007; Norberg & Green, 2007; Stuber, 1995). Receiving a pediatric cancer diagnosis creates a sense of helplessness for parents because of its uncontrollable nature (Greening & Stoppelbein, 2007). It is one of the most traumatic events that a family can be forced to endure (Fletcher, 2011). Nine to forty percent of parents experience depression, posttraumatic stress disorder, and generalized anxiety disorder for up to three years after their child's diagnosis (Greening & Stoppelbein, 2007). Pediatric malignancies are perceived by parents as life-threatening even though there has been a dramatic increase in effective treatments and children's prognoses (Stuber, 1995). However, the diagnosis of childhood cancer is traumatic and perceived by parents as a life threat for their child. It is stressful for the patients, but equally or more traumatic for their families, especially the parents (Fletcher, 2011; Stuber, 1995). <br /><br /> Further, the child or adolescent patient may interactively respond to the parents' stress reactions to their child's diagnosis. In effect, children may interpret the danger and trauma of the diagnosis according to their mothers' responses. Stuber (1995) likened the psychological sequelae of pediatric cancer diagnoses to post traumatic stress in child and adolescent patients and their parents. The child or adolescent patient experiences anxiety similar to combat veterans, although it is the parents who are at a far greater risk of post traumatic stress (Stuber, 1995). <br /><br /><b> Affects of Treatment on Children and Adolescents and Their Families </b><br /> The effects of treatment on the child or adolescent patient are numerable and have been associated with psychological and physiological effects (Gorin & McAuliffe, 2008; Mertens, et al., 2002; NCI, 2014). These effects can cause deficits in basic essential functions as well as secondary cancers, which are common and expected in congenital retinoblastoma. When the removal of the eye is involved, this has obvious implications for the child's eyesight. For children whose treatment is more complex or long-term, deficits in thought and learning processes may occur, which place them at risk for keeping pace with peers and classmates (Gorin & McAuliffe, 2008; NCI, 2014; O'Leary, Krailo, Anderson, & Reaman, 2008). Many children require special education and this can have a profound effect on children and their peer relationships (Gorin & McAuliffe, 2008). <br /><br /> Stuber (1995) found children did not necessarily appreciate the life-threatening aspect of cancer, but found treatment the more difficult component of the disease. Mothers serve as buffers for their children's treatment experience, although the psychological and physiological cost to mothers is significant (Stuber, 1995). The treatment of cancer involves contending with side effects, the limitations of maintaining a normal schedule, the disruption of social interactions and typical family roles. For example, older siblings may have to double as parents during times when parents must work or be available for other siblings or social events. "The increased burdens and stressors that accompany childhood cancer present formidable challenges for parent and family functioning" (Pai et al., 2007, p. 407). <br /><br /> Family conflicts, too, may occur because of the changing roles of families with a child or adolescent patient. Parents may have increased expectations of siblings because caring for the ill child is demanding and daunting for parents (Pai et al., 2007). This can cause conflict between siblings and between siblings and parents. Parents may feel an increased parenting burden, even after successful treatment has been completed (Norberg & Green, 2007). Often during cancer treatment, the relationship is strained between parents and healthy siblings, and they can become distant. Siblings may also exhibit socio-behavioral reactions, such as acting out, anger, fear, or clinginess (Norberg & Green, 2007). <br /><br /><b> Conclusion </b><br /><br /> Receiving a diagnosis for congenital retinoblastoma is a tragic and traumatic experience for families. Although medical science has increased the number of effective treatments and the rate of survival for diagnosed children, this disease has the potential to ravage families because of the psychological costs extorted from the patient and each family member. The initial diagnosis is perceived as a life threatening crisis, especially for the parents, and the ongoing treatment creates significant and sometimes insurmountable challenges that leave remnants of psychological stress for years. <br /><br />References <br /><br />American Cancer Society. (2014a). Thermotherapy for retinoblastoma. Retrieved March 22, 2014, from http://www.cancer.org/cancer/retinoblastoma/detailedguide/retinoblastoma-treating-thermotherapy <br /><br />American Cancer Society. (2014b). Cryotherapy for retinoblastoma. Retrieved March 22, 2014, from http://www.cancer.org/cancer/retinoblastoma/detailedguide/retinoblastoma-treating-cryotherapy <br /><br />American Cancer Society. (2014c). Chemotherapy for retinoblastoma. Retrieved March 22, 2014, from http://www.cancer.org/cancer/retinoblastoma/detailedguide/retinoblastoma-treating-chemotherapy <br /><br />American Cancer Society. (2014d). How is retinoblastoma treated? Retrieved March 22, 2014, from http://www.cancer.org/cancer/retinoblastoma/detailedguide/retinoblastoma-treating-general-info <br /><br />American Cancer Society. (2014e). High-dose chemotherapy and stem cell transplant for retinoblastoma. Retrieved March 22, 2014, from http://www.cancer.org/cancer/retinoblastoma/detailedguide/retinoblastoma-treating-high-dose-chemo-stem-cell <br /><br />Carter, J. (2009). Recognizing the signs of retinoblastoma. Practice Nursing, 20(8), 394-397. <br /><br />Dommering, C., Marees, T., van der Hout, A., Imhof, S., Meijers-Heijboer, H., Ringens, P., & ... Moll, A. (2012). RB1 mutations and second primary malignancies after hereditary retinoblastoma. Familial Cancer, 11(2), 225-233. doi:10.1007/s10689-011-9505-3 <br /><br />Fletcher, P. C. (2011). My Child has Cancer: Finding the Silver Lining in Every Mother's Nightmare. Issues In Comprehensive Pediatric Nursing, 34(1), 40-55. doi:10.3109/01460862.2011.557905 <br /><br />Gorin, S. S., & McAuliffe, P. (2008). Implications of childhood cancer survivors in the classroom and the school. Health Education, 109(1), 25–48. <br /><br />Greening, L., & Stoppelbein, L. (2007). Brief Report: Pediatric Cancer, Parental Coping Style, and Risk for Depressive, Posttraumatic Stress, and Anxiety Symptoms. Journal Of Pediatric Psychology, 32(10), 1272-1277. doi:1o.1o93/jpepsy/jsmo57 <br /><br />Mertens, A. C., Yasui, Y., Neglia, J. P., Potter, J. D., Nesbit, M. E., Ruccione, L.,...Robison, L. L. (2002). Late Mortality Experience in Five-Year Survivors of Childhood and Adolescent Cancer: The Childhood Cancer Survivor Study. Clinical Pediatrics, 41(1), 64-65. doi: 10.1177/000992280204100115 <br /><br />Norberg, A. L., & Green, A. (2007). Stressors in the Daily Life of Parents After a Child's Successful Cancer Treatment. Journal of Psychosocial Oncology, 25(3), 113-122. doi: 10.1300/J077v25n03_07 <br />
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the Children's Oncology Group. Seminars In Oncology, 35(5), 484-493. <br /><br />Pai, A. H., Greenley, R., Lewandowski, A., Drotar, D., Youngstrom, E., & Peterson, C. (2007). A meta-analytic review of the influence of pediatric cancer on parent and family functioning. Journal Of Family Psychology, 21(3), 407-415. doi:10.1037/0893-3200.21.3.407 <br /><br />Sacchetto, U., da Lustrosa, C., & Miyuki, R. (2002). Congenital retinoblastoma: report of a case Retinoblastoma congênito: relato de caso. Arquivos Brasileiros De Oftalmologia, (5), 571 <br /><br />Stuber, M. L. (1995). Stress responses to pediatric cancer: A family phenomenon. Family Systems Medicine, 13(2), 163-172. doi:10.1037/h0089256 <br /><br /> <br /><br /><br /><br /><br /> <b style="mso-bidi-font-weight: normal;"><br style="mso-special-character: line-break;" />
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Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-87862226678230022282014-03-29T08:48:00.006-10:002014-03-29T08:48:45.408-10:00Potential Affects of Childhood Cancer<!--[if gte mso 9]><xml>
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<![endif]--><b>Potential Affects of Childhood Cancer on Academic Achievement </b><br /><br />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). <br /><br />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). <br /><br /><b>Affects of Childhood Cancer on Peer Relationships </b><br />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). <br /><br />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. <br /><br /><b>Strategies to Help </b><br /><br />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). <br /><br />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. <br /><br />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 <br /><br />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. <br /><br />Eiser, C. (1998). Practitioner review: Long-term consequences of childhood cancer. Journal Of Child Psychology & Psychiatry & Allied Disciplines, 39(5), 621. <br /><br />Gorin, S. S., & McAuliffe, P. (2008). Implications of childhood cancer survivors in the classroom and the school. Health Education, 109(1), 25–48. <br /><br />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. <br /><br />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 <br /><br />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 <br /><br />National Cancer Institute (NCI). (2014). Late Effects of Treatment for Childhood Cancer (PDQ®). Retrieved March 23, 2014, from http://www.cancer.gov/cancertopics/pdq/treatment/lateeffects/Patient/page1 <br /><br />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. <br /><br />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. <br /><br />St. Jude Research Hospital. (2014). School program presented by Target. Retrieved March 23, 2014, from http://www.stjude.org/stjude/v/index.jsp?vgnextoid=f87d4c2a71fca210VgnVCM1000001e0215acRCRD <br /><br />Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0tag:blogger.com,1999:blog-7723773772499862499.post-70461188328634072672014-03-29T08:46:00.008-10:002014-03-29T08:46:52.141-10:00Age Appropriate Management of Childhood Diabetes<!--[if gte mso 9]><xml>
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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. <br /><br />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. <br /><br /><b>Two Potential Barriers for Effective Management </b><br />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). <br /><br /><b>Behavioral Strategy for Self Management </b><br /><br />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. <br /><br />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). <br /><br />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). <br /><br /> References <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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.Deborah Stonehttp://www.blogger.com/profile/14187722751093984919noreply@blogger.com0