Issues of adolescent development for survivors of childhood cancer.
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Biomedical subjects
Publications and source records attributed to G K Fritz.
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As plans for massive public AIDS education grow, pediatricians will become increasingly involved with school systems as consultants and leaders. A review of relevant literature on students' current level of knowledge about AIDS and on educational efforts to date with high-risk groups (homosexuals and intravenous drug users) provides the rationale for school-based AIDS education. Literature describing the approaches used and the impact of programs for sex education, drug abuse prevention, and reduction of prejudice towards the disabled is reviewed to extrapolate that which applies to AIDS education. Important developmental characteristics of adolescents are discussed insofar as they have implications for the planning of AIDS curricula.
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We surveyed 1,089 fellows of the American Academy of Pediatrics regarding (1) their experiences with child psychiatrists during training, (2) their current utilization preferences and practice with psychiatrists and other mental health professionals, and (3) differences in responses between pediatricians who completed ambulatory pediatric and related training and other pediatricians with respect to the aforementioned questions. Of those pediatricians who had contact with psychiatrists during training, more than 68% remembered the psychiatrist as being helpful. There was a strong preference on the part of all respondents for referral to a "behaviorally oriented pediatrician" for selected psychosocial problems. The pediatricians trained in ambulatory pediatrics believed they were more competent to treat the psychosocial problems of their patients than did other pediatricians and indicated more collaborative activities with psychiatrists than did other pediatricians.
This study employed a modified Rotter Level of Aspiration (LOA) task to assess parents' goal setting for their children. The sample of 64 children (ages 6 to 13) and their 128 parents contained 16 triads from each of four groups: Asthmatic, asthma sibling, diabetic, and normal. Parents indicated their own goals for their children and could influence the goals that the children set for themselves. Aspects of general family functioning also were assessed. Mothers of asthmatic children showed no significant goal setting differences from comparison mothers. These mothers were less, rather than more, controlling, and there was no support for the theory that mothers of asthmatic children are narcissistically overcontrolling. Fathers of asthmatics were more rigid and less accommodating in their goal setting, and fathers of all chronically ill children had higher LOAs than did control fathers.
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As a first step toward improving the quality of training for child psychiatrists in the increasingly important area of consultation-liaison work, a survey of current educational experiences in child psychiatry programs was carried out. Sixty-four programs (61% of those sampled) responded to a questionnaire and request for information. The consultation-liaison field remains minimally emphasized, as three-fourths of the programs devote less than 11% of the fellowship training time experiences to this area. Variations in the rotations are summarized, and five reasons for the low priority of consultation-liaison training are proposed.
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Enuresis and encopresis must be seen as symptoms, not diseases, occurring in heterogeneous groups of children. A number of known factors are etiologically relevant to each symptom, and it is likely that others remain to be discovered. Both enuresis and encopresis are truly psychosomatic entities, in which psychosocial and physiologic elements act and react with one another in the development and maintenance of the problem. Further research, emphasizing concurrent psychological and biologic evaluation, is needed to answer the many still remaining questions about the etiology, natural course, and treatment of these common childhood symptoms. Psychiatrists should be available as consultants to colleagues in primary care during the evaluation of enuretic and encopretic children and should be ready to treat a subgroup of symptomatic children who have identifiable psychopathology.
With many asthmatic children for whom emotional factors are significant, joint pediatric and psychiatric management is essential. A three-level model of collaboration is presented, including (1) pediatric care, (2) psychiatric consultation, and (3) inpatient psychosomatic treatment. The organization, professional roles, and treatment protocol of the psychosomatic inpatient service are described. A review of the first 16 asthmatic children who received inpatient care in the program suggests that such a model may present a viable alternative to long-term residential care.
Recently pediatric literature has noted that pediatric facilities often function as mental health facilities for their patients. There is little acknowledgment of the role of the pediatric social worker in such care. This paper reviews one year of child psychiatry consultations in a pediatric chronic illness hospital, with particular attention paid to quality of social work, pediatric and psychiatric collaboration. In the study year, 72 psychiatric consultations were requested for medical patients, the majority of which were requested by the social worker assigned to the medical service. Organizational and theoretical issues of the psychiatric consultation-liaison and social work service are discussed as well as disposition of consultations. From the data presented, close collaboration between pediatricians, social workers and child psychiatrists can be efficient, effective and offer a high level of continuity for mental health care of children with chronic illness.
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Results of a questionnaire assessing pediatricians' perceived competence regarding psychosocial, developmental and traditional medical problems were analyzed. The data were compared with a similar questionnaire distributed to seventh grade teachers, youth and parents assessing problems for which pediatricians were utilized. The results reveal that pediatricians rate their competency higher in the area of traditional medical problems. The implications of this study are discussed.