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L13 Behavior Issues - Children with Chronic Illnesses
Creighton University School of Medicine
43
Medical
Professional
02/27/2013

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Cards

Term
How long must an illness occur for it to be considered chronic?
Definition
> 3 - 6 months
Term
What are some characteristics of a chronic illness?
Definition
-Affects child’s daily activities
-Lifestyle change
-Requires hospitalizations/home health care/extensive medical care
-Continuous behavioral adaptation
Term
What are some examples of a chronic illness?
Definition
-Asthma
-Congenital heart
-Seizure disorder
-Diabetes mellitus
-Genetic d/o: T21
-Cystic fibrosis
-Leukemia
-Arthritis
-Hemophilia
-Sickle cell anemia
-Renal failure
-AIDS
-Spina bifida
Term
What percentage of americans do chronic illnesses affect?
Definition
10-20%
Term
Most cases of chronic illness are mild, what are some examples of mild chronic illnesses?
Definition
Allergies, acne, congenital deformity
Term
What % of those with mild chronic illnesses survive to adulthood?
Definition
>80-90%
Term
What are some general signs/symptoms you might see in a person with a chronic illness?
Definition
-Loss of social/physical activities
-Extreme stress
-Physical differences
Term
How can stress affect a child and how might they cope with it?
Definition
-Children are vulnerable to change
-Each child deals with stress differently
-May become introspective/withdrawn
-Older children: engage in substance abuse
Term
What are some behavior issues you might see with younger children w/ chronic illnesses?
Definition
-Tantrums
-Sleep disorders
-Feel out of control of environment
Term
What are some behavior issues you might see with older children w/ chronic illnesses?
Definition
-Sexual conduct
-Substance/alcohol abuse/cigarette use
-weapons
Term
What happens to the rate of behavior disturbances for those with chronic illnesses?
Definition
Chronic illness doubles the rate for behavior disturbances
Term
What happens to the risk of behavioral outcomes as the severity/life threatening-ness of the disease increases?
Definition
The risk increases
Term
When is a patient with a chronic illness at the most risk for changing behavior?
Definition
In the 1st year after the diagnosis
Term
If a patient has an earlier onset of illness, what happens to the risk of behavioral problems?
Definition
Lower risk in behavioral problems
Term
What are some factors that affect behavior outcomes in children with chronic illnesses?
Definition
-Disease features
-Family dynamics
-Coping strategies
Term
What is the most common behavioral outcome/change in a child with a chronic illness?
Definition
adjustment disorders
Term
What percentage of children with DM experience a behavioral outcome/change?
Definition
30-60%
Term
What factors cause a lower incidence of behavioral changes/outcomes?
Definition
-family cohesion
-higher level of expressiveness
-lower family conflict
Term
What are some characteristics of internalizing behaviors in children with chronic illnesses?
Definition
-Anxiety and depression
-Somatic complaints
-Social withdrawal
-Higher incidence vs. healthy children
-Subclinical: difficult to identify
Term
What are some characteristics of externalizing behaviors in children with chronic illnesses?
Definition
-Aggression and non-compliance
-Not as common as internalizing
-Increase overall family stress
Term
What are some characteristics of coping strategies for children?
Definition
-Must assess at visits
-Avoidance mechanisms: poorer outcomes
-25%: seek mental health services
-Depends on developmental stage
Term
Coping strategies for dealing with chronic illnesses (first year of life, characteristics)
Definition
-Building trust/sense of security
-Do not understand illness
-Behavior: reflection of coping with pain, separation from parents
-Presence of parents essential
-I can be taken care of”
-“Other people can do things for me”
-“Life is better when I cry, mom comes and takes care of me”
-“When I am unhappy and crying, mom comes along and makes it better”
Term
What is the order of stages in the oral cycle of bonding (1st year of life)?
Definition
Need -> Rage (helplessness, hopelessness, anger) -> Relief (eye contact, smiles, touch, lactose) -> Trust -> Need
Term
Coping strategies for dealing with chronic illnesses (second year of life, characteristics)
Definition
-Use stories/drawings to help understand illness
-Beginning explaining to child in simple words/ideas
Term
Coping strategies for dealing with chronic illnesses (preschool age, characteristics)
Definition
-Developing independence
-Treatment: represents lack of control
-Often will test boundaries: to gain some sense of control
-Maintain firmness, but give options
Term
Coping strategies for dealing with chronic illnesses (early school-age/5-8, characteristics)
Definition
-Magical thinking
-“ I caused illness with bad thoughts”
-Sense they are different
-Allow choice/sense of management of illness
Term
Coping strategies for dealing with chronic illnesses (older school-age/preteen, characteristics)
Definition
-Understand illness and treatment
-Maintain regular schedules/friends and activities
-Honesty in treatment
Term
Coping strategies for dealing with chronic illnesses (adolescents, characteristics)
Definition
-Own identity: separate from family
-Self image
-Denial of illness
-Help teens gain control of illness
Term
What % of adolescents with chronic illess participate in risky behaviors?
Definition
10% (1 in 10)
Term
Are adolescents with chronic disease more likely to participate in risky behaviors?
Definition
yes
Term
What are some characterisitics of risky behaviors in adolescents w/ chronic illness?
Definition
-More likely depressed
-More likely to smoke daily, current canabis users
-More likely to have performed violent or antisocial behaviors
-Problems gaining access to social peer groups
-Socialize more with risk-taking peers
-Greater need to be accepted
-Demonstrate their “normalcy”
-Higher rates of emotional distress
-Believe they have “shorter life span”
-Feel more reckless, “live life to fullest”
-Behaviors: lead to increased disease complications
Term
Do adolescents with chronic illnesses infrequently receive preventative counseling?
Definition
yes
Term
What are adolescents with chronic illnesses uncommonly screened for?
Definition
substance abuse/sexuality issues
Term
Why are adolescents with chronic illnesses infrequently counseled on prevention and substance abuse/sexuality issues?
Definition
less likely to be alone with physician
Term
Where does greater emphasis need to be placed on adolescents with chronic illnesses?
Definition
on preventative counseling
Term
adherence to treatment (under age 8)
Definition
unlikely to understand
Term
adherence to treatment (12-14 years)
Definition
understand link between actions and effects on illness
Term
Adherence to treatment depends upon what 3 factors?
Definition
-Complexity of regimen
-Stages of disease (asymptomatic: decreased adherence)
-Family dynamics
Term
How does one deal with behaviors resulting from chronic illnesses?
Definition
-Build self-concept
-Share control/decision-making
-Provide empathy before consequences
-Share thinking/problem solving
Term
In children with chronic illness, at what time after diagnosis of illness, do behavioral issues most commonly emerge?
A) within one month of dx
B) within 6 months of dx
C) within one year of dx
D) between 1-2 months after dx
Definition
C) within one year of dx
Term
Concerning behavioral issues, which strategy is most apt to produce positive results?
A) allow some “bending” of rules, since they are dealing with health issues
B) re-enforce positive behavior with rewards
C) only point out negative behavior
D) allow child to have some decision-making in the process of treatment, feeling of control
Definition
D) allow child to have some decision-making in the process of treatment, feeling of control
Term
What would be an essential portion of a health care visit for a adolescent patient with chronic illness?
A) discussion of family issues
B) evaluation for depression/anxiety about illness
C) inquiry about drug/alcohol/tobacco usage
D) inquiry about progress in school
E) their perception about weight issues
Definition
C) inquiry about drug/alcohol/tobacco usage
Term
A two month old female with a congenital heart condition, has been hospitalized since birth. Parents have been present for the majority of the time at her bedside. What situation describes a normal development pattern for a newborn with a chronic condition?
-During blood draws, baby does not cry or notice the needle
-Avoids smiling/cooing at her caregivers
-Baby sleeps for only one hour at a time both day and night
-When patient cries, caregivers respond, causing baby to be soothed and comforted quickly.
Definition
When patient cries, caregivers respond, causing baby to be soothed and comforted quickly.
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