Chapter 13

Question 1

What percentage of children and adolescents in North America have a diagnosed chronic
illness or potentially life-limiting medical condition? What are some examples of those conditions?

Answer 1

> Up to 25 per cent of children
i.e., asthma, diabetes, or cancer

Question 2

What is the most commonly diagnosed form of Cancer in children? Have survival rates improved?

Answer 2

> pediatric acute lymphoblastic leukemia

> survival rates have improved dramatically, from 70 per cent in the 1980s to 90 per cent in recent years (

Question 3

With advances in modern medicine, a range of available medical treatments now can reduce condition-related symptoms and improve quality of life - but what should be noted about these advances?

Answer 3

> these medical treatments are often complex and multi-faceted

> include many medications, dietary restrictions, and physical therapy.

> often experience psychological effects associated with their conditions and multiple interactions with the health-care syste

> can also experience cognitive and psychological effects as a direct result of their treatments

> chronic medical conditions in child-hood can be associated with psychological issues in adulthood

Question 4

Millions of children and adolescents in North America now live with chronic illnesses and medical conditions that can contribute to what?

Answer 4

> can contribute to significant emotional and behavioural difficulties and negatively impact treatment adherence and child and family adjustment.

Question 5

Are there disparities in pediatric health care?

Answer 5

> yes but for those children belonging to minority groups, including:
disproportionate rates of disease incidence,
treatment adherence and response,
and differences in risk factors

Question 6

Why was the field of pediatric psychology developed?

Answer 6

> developed to address the needs of patients in pediatric settings and brings together several areas within psychology, including health, clinical, and de-velopmental psychology.

Question 7

Who coined the term “pediatric psychology” and what does it mean?

Answer 7

> the term “pediatric psychology” was first coined in 1967 by Logan Wright in the article “The pediatric psychologist: A role model,”

> and was defined as “dealing primarily with children in a medical setting which is non-psychiatric in nature”

Question 8

Today, the field of pediatric psychology is acknowledged as what?

Answer 8

> a specialized field within health psychology that integrates both scientific research and clinical practice to address the psychological aspects of children’s medical conditions and the promotion of health behaviours in children and their families.

Question 9

The professional face for the field of pediatric psychology is what division of the APA?

Answer 9

> is the Society of Pediatric Psychology (SPP), which is Division 54 of the American Psychological Association (APA)

Question 10

What is the goal of the SPP?

Answer 10

> he Society aims to promote the health and psychological well-being of children, youth, and their families through science and an evidence-based approach to prac-tice, education, training, advocacy, and consultation.

Question 11

SPP publishes two journals: what are they?

Answer 11

> the Journal of Pediatric Psychology (JPP) and Clinical Practice in Pediatric Psychology (CPPP).

• Founded in 1967, JPP pri-marily publishes empirical research articles that examine theory and intervention in pediatric psychology.
• CPPP was established in 2013 as a peer-reviewed forum to publish research articles, reviews, and commentaries focused on professional and clinically applied issues in the field.

Question 12

Pediatric psychologists deal with a number of cross-cutting themes in their care - what are some?

Answer 12

1) coping with chronic medical conditions,

2) adherence to pediatric treatment regimens,

3) coping with medical procedures,

4) pediatric chronic pain, and pediatric palliative care.

Question 13

pediatric psychologists have expertise in dealing with health issues unique to childhood that often present as significant parenting challenges, including:

Answer 13

> sleeping
feeding
toileting problems
The impact of pedi-atric chronic medical conditions on parents and siblings

Question 14

How a child copes with a chronic medical condition is related to what kind of outcomes?

Answer 14

> patient outcomes

Question 15

How does a chronic medical condition begin in children?

Answer 15

> Typically, a chronic medical condition begins with a sudden onset of medical symptoms (e.g., fatigue, pain, fever), which prompts the family to seek initial medical consultation and care.

> this initial phase concludes with diagnosis of a specific medical condition and identification and implementation of an appropriate medical management plan.

• NOTE: a clear medical diagnosis and accompanying management plan may not always be immediate or evident (evident in those with chronic pain).

Question 16

Provided an appropriate diagnosis and manage-ment plan are identified, the child and family enter what phase [in the development of chronic medical conditions]

Answer 16

> enter a longer-term phase where they gradually adjust to the impact of the medical condition and management on their day-to-day lives.

Question 17

What kind of “course” is associated with a chronic medical condition in children?

Answer 17

> an uncertain course associated with their condition

> i.e., conditions such as inflammatory bowel disease and arthritis, are associated with flares or crises that may be unpredictable

Question 18

Children with chronic medical conditions face a range of stressors associated with what? Do they have other stressors aside from this?

Answer 18

> associated with their conditions and management.

> These stressors are in addition to the typical stressors associ-ated with normal development (e.g., challenges with peer relationships, school transitions) experienced by all children

Question 19

Rodriguez et al. (2012) surveyed children with cancer and their parents regarding percep-tions of stressors associated with childhood cancer. The three most common areas of stres-sors identified by children included what?

Answer 19

(1) interruptions in daily role functioning

(2) physical effects associated with treatment

(3) uncertainty about the cancer

Question 20

In Rodriguez’s study (2012) what was the most frequently experienced / stressful stressor experienced by children and as a result what is them ost problematic thing for children with pediatric conditions?

Answer 20

> children reported inter-ruptions in their daily role functioning as the most frequently experienced + stressful stressort

> indicating that it is the disruption of typical activities and tasks associated with childhood, rather than the specific limitations imposed by a medical condition itself, that is most problematic for children.

Question 21

In Rodriguez’s study (2012) what did it reveal about stressors reported by parents?

Answer 21

> reported cancer caregiving as most stressful

> They also reported high levels of stress associated with interruptions in daily role functioning (e.g., paying bills, having less time for other children) and cancer communication (e.g., talking with their child or others about cancer).

Question 22

Parents who expressed high levels of stress in the areas of cancer caregiving and cancer communication were more likely to report what kind of symptom?

Answer 22

> were more likely to report post-traumatic stress symptoms as a result of their child’s condition.

Question 23

The extent to which a stressor is perceived as stressful depends on a number of internal and
external factors associated with what?

Answer 23

> associated with the child, parent, and the specific medical condition.

Question 24

What affects how a child copes?

Answer 24

> A variety of developmental and familial factors

Question 25

Coping with medical conditions in children is intertwined with what?

Answer 25

> intertwined with development.

Question 26

As chil-dren get older, coping approaches change and become more sophisticated. Provide a specific example of this:

Answer 26

> the use of behavioural strategies is more common in early childhood

> but later evolves into more complex cognitive strategies in later adulthood.

Question 27

How doe medical conditions vary in children? What are these variables considered in the field of children’s coping with medical conditions?

Answer 27

> vary in their level of associated symptoms and challenges across conditions

> considered in theoretical conceptualizations of children’s coping with medical conditions

Question 28

A recent review of coping with chronic illness in childhood and adolescence was published by Compas and colleagues (2012). What kind of coping model was it and what 3 pairs of coping did they discover?

pc/ac - sc/ac, d/pc

Answer 28

> they present a control-based model of coping

> includes primary control or active coping (i.e., efforts to act on the source of stress or one’s emotions),

> secondary control or accommodative coping (i.e., efforts to adapt to the source of stress), and

> disengagement or passive coping (i.e., efforts to avoid or deny the stressor).

Question 29

Children in a variety of medical conditions, including diabetes, chronic pain, and cancer, who engage in what kind of coping (under Compas et als’ model) generally adjust and cope better?

Answer 29

> those that engage in secondary control coping, generally adjust and cope better than children who use disengagement coping.

Question 30

Is their one conceptual model that explains children’s coping with medical conditions?

Answer 30

> the lack of a universal conceptual model for guiding research has been a challenge for those conducting work in this area.

Question 31

An additional challenge in the study of children’s coping with medical conditions is what?

related to measurment…

Answer 31

> is the difficulty associated with appropriate assessment

> measures of stress and coping in children typically require them to rate the extent to which they find various aspects of their medical condition stressful + the degree to which they engage in a variety of coping strategies

Question 32

Most of what we know about the assessment of children’s medical stress and coping is in the area of what?

Answer 32

> the area of children’s pain

Question 33

The best-known coping questionnaire that has been used across various childhood medical conditions and in children ranging in age from 7 to 16 years is which? What does it do?

Answer 33

> the Kidcope

> Similar to other coping measures, children rate commonly used coping strategies (e.g., problem-solving, distracting), but also the degree of anxiety, unhappiness, and anger experienced in dealing with stressful situations related to their condition.

Question 34

The review by Blount et al. (2008) was helpful in identifying what? How was this important to the field?

Answer 34

> coping and stress measures that can be used both in research and in clinical practice with children with medical conditions.

> made important contributions to the field by highlighting the importance of improving assessment of children’s coping to advance the field and to test the efficacy of interven-tions aimed to improve children’s coping.

Question 35

psychological interventions to improve coping have taken many forms, ranging from what? What are they referred to as?

Answer 35

> ranging from simple provision of written materials to more intensive individual or group interventions

> are often referred to as psycho-educational because they typically include basic information about disease management in addition to providing instruction in specific cognitive behavioural coping skills

Question 36

The strongest research support is for the efficacy of psycho-educational interventions that incorporate cognitive behavioural techniques in improving a range of outcomes, including:

SE,SMOD,FF,GPWB,RI,SC,K,H

Answer 36

> self-efficacy,
self-management of disease,
family functioning,
general psychosocial well-being,
reduced isolation,
social competence,
knowledge, and
hope

Question 37

What are the specific types of physiological improvements in a number of disease-specific outcomes for various medical conditions such as headache, asthma, and diabetes…

RP - HA. IPF- A, IMB-D

Answer 37

> these interventions can produce reduced pain (for headache),

> improved pulmonary function (for asthma),

> and improved metabolic control (for diabetes) in the short and long terms

Question 38

High rates of non-adherence to treatment have been reported across numerous pediatric conditions (Kahana, Drotar, & Frazier, 2008) with an estimated overall non-adherence rate of what percentage?

Answer 38

> an estimated overall non-adherence rate of 50 per cent for pediatric patients across various medical conditions

Question 39

milar to adult outcomes, non-adherence is known to be associated with what?

Answer 39

> increased morbidity, use of the health system, and mortality

Question 40

Numerous variables have been associated with adherence to treatment in children
(Modi et al., 2012). These include:

CA,CED, FF, DATSPC

Answer 40

> child age, child emotional development, family factors, and disease-and treatment-specific considerations.

Question 41

Adolescents are at particularly high risk for non-adherence to prescribed medical regimens, potentially due to what?

Answer 41

> less parental involvement and other developmental aspects of adolescence.

Question 42

More complex treatment regimens generally are associated with lower levels of what compared to more simpler regiemenes?

Answer 42

> associated with lower levels of adherence

Question 43

Across medical conditions, greater levels of both child and parental involvement in condition management have been associated with what?

Answer 43

> improved adherence and better outcomes.

Question 44

A variety of creative interventions have been developed to improve adherence. name some:

RBI, M, GS, CC, PS, LMWER

Answer 44

> Reinforcement-based interventions, i.e. sticker charts

> monitoring

> goal setting,

> contingency contracting,

> problem solving,

> and linking medication with established routines

Question 45

More complex regimens typically require what?

Answer 45

> require more intensive education and intervention, such as instruction in social support and family-based problem solving

Question 46

Education efforts alone generally are insufficient to promote what? What needs to be added?

Answer 46

> adherence

> adding a behavioural-management component enhances adherence-related outcomes

Question 47

What are multi-component interventions?

They incorperate a variety of SST, OR FT

Answer 47

> are interventions that incorporate some variety of social skills training or family therapy

Question 48

What percentage of children have issues with swallowing pills?

Answer 48

> Up to 20 per cent of children have difficulty swal-lowing pills (

Question 49

What experience is frequently cited as among the most feared experiences of children? Does this apply to all children or only those with medical condtions? Does the fear persist overtime and if so who does it cause distress for?

Answer 49

> Needle procedures, such as immunizations and venepuncture, and the pain associated with such procedures

> this fear also applies to healthy children and children with chronic medical conditions

> these fears tend to persist over time and can cause considerable distress not only for the child, but also for his or her parents, siblings, and any health professionals working with the child.

Question 50

Out of 10, how many people avoids medical procedures, such as immunization, due to severe needle-related fears or phobias? Which people are less likely to recieve these medical procedures as a result of their fear?

Answer 50

> 1/10 people

> Children with significant fears towards medical procedures are likely to avoid seeking appropriate health care in the future

Question 51

Painful medical procedures are commonplace even for healthy children, who now undergo how many routine immunizations by age five?

Answer 51

> up to as many as 20 routine immunizations by age five.

Question 52

What kind of child is at an elevated risk for experiencing repeated painful medical procedures?

Hint - they are not really a child yet…

Answer 52

> Preterm infants who spend time in the neonatal intensive care unit (NICU)

Question 53

the majority of children under-going painful medical procedures receive what? Provide an example that displays this fact:

Answer 53

> receive no pain-relieving interventions.

> For example, a recent survey of procedural pain management practices at eight children’s hospitals across Canada showed that 80 per cent of hospitalized children experienced at least one painful procedure over the previous 24 hours (the average was six procedures per child) and more than two-thirds of these procedures had no documented pain management intervention (either pharmaco-logical, psychological, or physical)

Question 54

A recent study showed that, after controlling for a range of clinical factors, the frequency of painful medical procedures was related to what kind of development?

Answer 54

> was related to impaired brain development in a sample of preterm infants hospitalized in the NICU

Question 55

Numerous studies in the field have documented a strong relationship between certain parent behaviours affecting a child’s health - provide an example:

Answer 55

> certain parent behaviours and increased child pain and distress,

> while other behaviours (e.g., use of distraction, humour) have been associated with child coping when used by mothers, fathers, and health professionals

Question 56

It has been suggested that parental reassurance likely serves as a signal to children that can be interpreted as what?

Answer 56

> that the parent is nervous or worried

Question 57

A study by McMurtry et al. (2010) involved a pairing of clinical and lab-based methodologies in children undergoing blood work to provide a detailed examination of the complexities of adult reassurance during painful medical procedures. What were the results regarding adult reassurance and a child’s heatlh? Which vocal tone made this especially the case?

Answer 57

> Results supported that children do indeed perceive their parents as more fearful and less happy when they reassure, and that this was particularly the case for reassurance spoken in a rising vocal tone (indicative of uncertainty)

Question 58

Children above the age of five years are generally able to provide self-reports of their pain using what kind of support tool? How do they use it and what faces can confound more general distress with pain and make pain more challenging to self-report for children?

Answer 58

> using validated self-report tools such as the Faces Pain Scale–Revised (FPS–R)

> Children use these scales to point to the face that best shows how much hurt or pain they have. It is important that scales for pain assess-ment begin with a relatively neutral face, as is the case in the FPS–R.

> faces that begin with a smiling face instead of a neutral face can confound more general dis-tress with pain and make pain self-report more challenging for children

Question 59

When children are unable to provide self-reports of pain, pain can be assessed how? Which measure underestimates child pain?

Answer 59

> use behavioural measures that assess either broad-band behaviours or fine-grained facial movements that quantify pain.

> research has shown that observer reports of child pain generally tend to underestimate a child’s pain

Question 60

In the case of psychological interventions specifically, strong evidence supports the use of what strategies?

Answer 60

> supports the use of cognitive behavioural strategies for decreasing pain and distress associated with medical procedures

Question 61

These reviews conclude that the psychological interventions with the most support include what three elements?

D,H, SCOCBI

Answer 61

1) distraction,
2) hypnosis,
3) and some combination of cognitive behavioural interventions

Question 62

Barriers to proper pain management are present at many levels, including:

P,PC, HCP, HCS

Answer 62

> including the level of the patient, primary caregiver, health-care provider, and the health-care system

Question 63

The publication and dissemination of the clinical practice guideline has already supported changes at a global level; in 2015, the World Health Organization (WHO) issued a policy on what?

Answer 63

> issued a policy on the mitigation of pain, distress, and fear during vaccinations, which was developed on the basis of the clinical practice guideline recommendations

> All national immunization programs are expected to implement the WHO’s policy to reduce vaccination pain.

Question 64

Parents have been the target of what with respect to pediatric conditions?

Answer 64

> of recent knowledge translation efforts aimed at communicating evidence-based strategies to reduce vaccination pain in their children.

Question 65

It is generally recom-mended that children above the age of five years receive what kind of notice for their medical procedures?

Answer 65

> receive at least a five-day notice for procedures, although this will vary depending on the age and temperament of the child and the severity of the procedure

Question 66

Jaaniste et al. (2007) provide a useful review and summary of how to best provide children with information about forthcoming medical procedures. They note the importance of what with respect to this issue?

Answer 66

> they note the importance of including both sensory and procedural information, of giving advice on coping skills, and of informing the child of whether the procedure is going to be painful, in neutral language.

Question 67

A population-based survey of Canadian adolescents aged 13–17 years found that approximately what percentage experience chronic pain?

Answer 67

> approximately 20 per cent of adolescents report experiencing weekly or more frequent chronic pains such as headaches, stomach aches, or backaches

Question 68

Chronic pain can occur as a result of what?

Answer 68

> associated medical conditions or in the absence of any identifiable organic pathology.

Question 69

It is important to note that not all children who experience chronic pain are significantly disabled by this pain. It is actually what group that experiences this interference?

Answer 69

> It is a subgroup of children (estimated at around 5 per cent) who experience significant pain-related interference

> for these children the negative conse-quences of their pain are far-reaching, affecting emotional functioning, school performance, peer relationships, sleep, and family functioning

Question 70

Pain was once viewed by scientists and clinicians as a purely biological phenomenon- how is it viewed now?

Answer 70

> but it is now understood that pain is a complex experience where psychological factors play an important role

Question 71

How many children experience chronic pain as adults?

Answer 71

> There is evidence that as many as two-thirds of children with chronic pain continue to experience chronic pain as adults, and psychological factors have been shown to play an important role in predicting this trajectory

Question 72

Core outcome domains for assessment of pediatric chronic pain include:

Answer 72

> pain intensity, but also physical functioning, emotional functioning, role functioning, and sleep

Question 73

What are the psychological interventions tested for pediatric chronic pain?

R, H, CST, BIOF, CBT

Answer 73

> he psychological interventions tested included relaxation, hypnosis, coping skills training, biofeedback, and cognitive behavioural therapy.

Question 74

Two recent reviews summarize the efficacy of psychological interventions for improving pain, disability, and mood in children with chronic pain delivered either face to face (Eccleston et al., 2014) or remotely (i.e., via the Internet, CD-ROMs, audiotapes, or the telephone) what was best?

Answer 74

> The reviews found that psychological treatments delivered face to face and remotely were effective in reducing pain intensity associated with both headache and non-headache pain.

> However, long-term therapeutic gains were limited to children and adolescents with headache who received face-to-face treatment.

> Overall, there was limited evidence for the effects of psycho-logical interventions on mood and disability

Question 75

While psychological interventions delivered on their own can certainly be helpful for some
children, many children with chronic pain require what?

Answer 75

> require more intensive, multidisciplinary interven-tions and are seen in clinics specializing in chronic pain

Question 76

In 2015, the pediatric chronic pain clinic at the Stollery Children’s Hospital in Alberta, Canada launched what program?

Answer 76

> launched Chronic Pain 35, an innovative education program, in collaboration with the provincial government

Question 77

What is Chronic Pain 35?

Answer 77

> Chronic Pain 35 allows teens in the chronic pain clinic enrolled in Grades 10 to 12 to earn high school credits for attendance at a group-based cognitive behavioural therapy program.

> The benefits of this program are multifaceted. By participating, teens are able to socialize with same-age peers and maintain their academic progress all while engaging in an evidence-based chronic pain intervention

Question 78

Over the last 20 years there has been tremendous growth in the field of pediatric palliative care, which originated within what field?

Answer 78

> oncology

Question 79

The field of pediatric palliative care can apply to what conditions now besides just oncology?

Answer 79

> including conditions where curative treatments have failed or that require intensive long-term treatment aimed at maintaining quality of life

Question 80

What percentage of children receive palliative care?

Answer 80

It is estimated that only 10 per cent of dying children each year receive hospice or palliative services

Question 81

The goals of pediatric palliative care are considered what? As a result, what four elements are established pediatric palliative care?

MF,1) GOFC, 2) SM 3) ACP 4) E & L C

Answer 81

> are multi-faceted
establishes goals of care,
establishes symptom (e.g., pain, fatigue) management,
establishes advanced-care planning,
establishes ethical and legal considerations.

Question 82

Pediatric palliative care is different from adult care in 4 ways - what are they?

Answer 82

> the types of medical conditions experienced by children are different,
their needs for education and support are different,
their family environment is different,
and their understand-ing of death and dying is different

Question 83

Pediatric psychologists also have considerable knowledge in dealing with several common parenting chal-lenges that are often problematic in healthy children as well as in children with medical condi-tions. These common challenges include:

Answer 83

> include difficulties in the areas of sleeping, feeding, and toileting.

Question 84

Sleep problems are a very strong correlate of what problems? Which children are affected most by sleep problems?

Answer 84

> Sleep problems are a very strong correlate of emotional and behavioural issues, and children’s sleep problems are known to exacerbate their emotional and behavioural problems

> Sleep problems are a greater issue for children with medical conditions

Question 85

The most common sleep difficulties in childhood include:

Answer 85

> bedtime resistance and night wakings.

Question 86

Many pediatric sleep problems can be managed effectively using what?

Answer 86

> using basic principles of sleep hygiene, such as deciding on appropriate bed and wake times and eliminating television and other screen use while in bed

Question 87

Feeding issues are a common concern of parents of young children. What are the two most common challenges, and what mealtime length is associated with feeding problems?

Answer 87

> trying to get children to eat food at assigned, structured mealtimes
and encouraging children to try new foods

> Mealtime lengths greater than 30 minutes are often associated with feeding problems

Question 88

Children’s eating behaviours are influenced by two types of earting - what are they and what 3 behaviours are associated with each?

Answer 88

> related to overeating or undereating.

> RELATED TO OVEREATING:
food responsiveness,
enjoyment of food
emotional overeating,

> RELATED TO UNDEREATING:
slowness in eating,
fussiness, or
refusal of new foods

Question 89

What are sleep 10 general sleep tips?

Answer 89

1. Recieve age appropriate amount of sleep
2. Set bedtimes + waketimes with evening routines
3. Consistency in bedtimes and waketimes
4. Schedules that incorperate bedtimes and waketimes
5. Location that has a comfortable bed, a quiet/dark/cool rooml; that remains consistent and familiar
6. No Electronics in the bedroom or before bed
7. Exercise and diet - cooldown period before bed and should not go to be hungry
8. Positivity - atmosphere should be positive
9. Independence when falling asleep once they reach the age to do so
10. Needs met during the day - including emotional and physical.

Question 90

What are two specific toileting issues?

Answer 90

> Enuresis and encopresis are two common yet often poorly understood toileting-related issues that occur in childhood and are often treated by pediatric psych-ologists

Question 91

What is Encopresis?

Answer 91

> Encopresis is defined as the passage of feces in inappropriate places, such as clothing.

> For the vast majority of these children (>90 per cent), this soiling occurs as the direct result of overflow incontinence, which is involuntary and results from constipation.

> the colon walls stretch and this leads to an accumulation of stool, creating a vicious cycle that can result in frequent soiling incidents.

> In some cases, this stretching of the colon can reduce a child’s sensitivity to the urge to defecate, further increasing the frequency of accidents.

Question 92

Evidence-based behavioural interventions for encopresis include:

Answer 92

> biofeedback and enhanced toilet training (ETT)

> With biofeedback, electrodes are placed in and/ or around the anus with the goal of teaching children to contract and relax their anorectal muscles to achieve ef-fective bowel movements

> ETT is a behavioural management program. ETT typically includes education about the nature of constipation and soiling, defe-cation modelling, breathing exercises, and behavioural reinforcements to encourage toilet use (Shepard et al., 2016). ETT has yielded outcomes superior to medical management

Question 93

What is Nocturnal enuresis? What percent of five year olds does it affect and when does it decrease? What percent struggle with this in adolescents? What gender is most common for it and what kind of intervention is most effective?

Answer 93

> Nocturnal enuresis (bedwetting) is also a common disorder and affects as many as 5 to 10 per cent of five-year-olds, decreasing in frequency with age, although 1 per cent of older adolescents are estimated to continue to struggle with it

> more common in boys

> urine alarm is the most effective intervention

.

Question 94

A systematic review identified 47 studies for six common childhood chronic illnesses (pain, cancer, diabetes, asthma, traumatic brain injury, and eczema) - Four types of therapy were directed towards parents were examined. What were the four types and: 1) which one was associated with improvements in the child’s medical symptoms, and which was assocaited with improved distress and problem solving in parents

Answer 94

> CBT,
family therapy,
problem-solving therapy,
and multi-systemic therapy.

> Cognitive behavioural therapy was found to be associated with improvements in the child’s medical symptoms,
while problem-solving therapy improved parents’ distress and their ability to solve problems.

Question 95

In addition to the impact on the child, parenting a child with a chronic or life-limiting illness can have a major negative impact on the child’s parents and family - provide some examples:

Answer 95

> taking care of a child with chronic illness can impact a parent’s ability to go to work, have a social life, care for other children, and accomplish necessary chores around the house.

Question 96

The needs of siblings of children with medical conditions have also been acknowledged. What does this mean?

Answer 96

> Frequently, having a child with a medical condition in the family can pull attention and resour-ces away from other children, placing them at risk for a range of negative outcomes.

Question 97

Vermaes, van Susante, and van Bakel (2012) examined the psychological functioning of siblings of children with a range of chronic physical and medical conditions such as cancer, diabetes, cystic fibrosis, and spina bifida. What was found?

Answer 97

> they found that having a sibling with a chronic health condition had a small but significant effect on siblings resulting in more internalizing and ex-ternalizing problems and less positive self-attributes (e.g., self-esteem, self-concept). Older sib-lings, and siblings of children with life-threatening (e.g., cancer) or highly intrusive disorders that impact daily life (e.g., diabetes), were at greater risk for negative outcomes

Question 98

Intervention programs have been developed to address the psychosocial needs of siblings - what has been found? What research specifically reported it?

Answer 98

> These interventions, usually group-based, typically include develop-mentally appropriate information regarding the sibling’s condition, coping skills training, and the opportunity to meet others with similarly ill siblings.

> Incledon and colleagues (2015) found that these types of treatments, in addition to emotional support from parents, and consistency in family routines, can effectively reduce psychological maladjustment in siblings of children with chronic conditions

Question 99

he application of technology in pediatric psychology over the past decade has allowed for signifi-cant advancements in what areas?

Answer 99

> in assessment, intervention, and research.

> A major development in the field has been the implementation of e-Health (electronic health) tools that deliver health services and information through the Internet and other related technologies.

> Additionally, Internet-based self-management interventions for youth with health conditions have been developed and reviews have found that these interventions are effective in improving symptoms across a range of common pediatric health conditions

Question 100

In recent years, the use of technologically enhanced distraction devices, such as humanoid robots, have emerged as novel tools to reduce procedural pain and distress in pediatric patients- what is a specific example of this?

Answer 100

> One example is MEDi, otherwise known as Medicine and Engineering Designing Intelligence.

> MEDi is an interactive humanoid robot (see photo of MEDi the humanoid robot) that can serve as an engaging, multisensory distraction tool for children undergoing medical procedures by dancing, playing games, and telling stories.

> MEDi can also be programmed to deliver cognitive behavioural interven-tions (e.g., deep breathing) and positive reinforcements (e.g., high fives).

Question 101

In one study, children undergoing routine vaccin-ations were randomized to receive usual care or to interact with MEDi during the procedure. Children in the MEDi condi-tion reported what outcomes?

Answer 101

> reported significantly lower pain and distress than those who received usual care, with effect sizes in the moderate to large range

Question 102

What is a subset of m-health?

Answer 102

> m-Health (mobile health) is a subset of e-Health that involves the use of mobile phones and other wireless technol-ogy (i.e., tablets).

Question 103

Social media have become an increasingly important research tool in pediatric psychology. What percentage of youths have social media?

Answer 103

> 91 per cent of youth between the ages 13 and 17 use social media.

Question 104

What is one benefit to using social media for pediatric psychology? Provide three examples of this:

Answer 104

> is a method to facilitate direct com-munication and engagement between clinicians, researchers, youth, and their families.

1) has been used to deliver health-promotion programs for children with medical con-ditions and their parents
2) run virtual focus groups,
3) and recruit hard-to-reach clinical populations.

Question 105

Recently, social media have also been used as what type of tool? What is a specific example?

Answer 105

> as a knowledge translation tool to deliver research evidence on pediatric health to parents in a way that is functional, ac-cessible, and that can be implemented in everyday life.

> One such example is the #ItDoesntHavetoHurt (#IDHTH) social media initiative.

Question 106

What is the #ItDoesntHavetoHurt (#IDHTH) social media initiative?

Answer 106

> # IDHTH is a science-media part-nership between the Centre for Pediatric Pain Research (Halifax, NS) and the Yum-myMummyClub.ca, (Canada’s leading online magazine for mothers) that places evidence-based information on pediatric pain management directly into the hands of parents through blogs, posts, videos, social media images, Twitter chats, and Fa-cebook polls

> As part of these initia-tives, parents can also engage with the research team over social media to ask questions, share their experiences, and identify priority areas for future research.