Abstract: One third of all children and adolescents among the population suffer from functional symptoms and pain disorders (including abdominal pain, headache, joint pain) without diagnosable biomedical correlate. A subgroup does not achieve a successful adaptation to these functional symptoms but develops a somatoform disorder that is associated with an excessive medical consultation behavior, hypochondriacal anxiety and significant psychosocial impairment (e.g. school absenteeism). This paper presents a behavioral medicine conceptualization of…the emergence of somatoform disorder, an approach to assessment and case formulation, and a behavioral medicine intervention comprising seven modules based on an individually tailored treatment indication. (1) Biopsychosocial conceptualization. It consists of a two-phase model that identifies the relevant factors and pathways contributing to the transition from functional symptoms to the emergence of a somatoform disorder. In terms of a theory-based intervention planning, the factors involved act as targets both for assessment and intervention. (2) Assessment strategies comprise patient and family history as well as a functional behavior analysis concerning the child's and the parents' cognition, emotion and behavior in critical episodes of symptomatic manifestation. In addition, rating scales, questionnaires and symptom diaries addressing frequency, intensity and spectrum of functional symptoms and pain as well as their management are administered. (3) Intervention. Diagnostic information and informed consent on treatment goals and setting determine an individualized treatment plan that may comprise seven major treatment modules: (1) pediatric therapy, (2) explaining the diagnosis of a benign functional disorder and patient education, (3) behavioral medicine strategies of pain and symptom relief (attention control, relaxation techniques, self-instruction), (4) cognitive restructuring of distorted, hypochondriac pain information processing, (5) control of precipitating, symptom-inducing stress factors, (6) modification of the parental response to pain communication of the child, (7) strengthening social integration into peer group and school. The empirical evaluation of behavioral medicine intervention programs is just beginning. Pilot studies in the field of functional gastrointestional disorders show a high efficacy of cognitive behavioral approaches which has already led to their implementation into national and international treatment guidelines.
Abstract: A paediatric cancer diagnosis may exceed the resources of the children, adolescents and their families. The goal of this article is to describe the status quo of paediatric psycho-oncology. First, the nature and prevalence of psycho-reactive symptoms will be described and a process-oriented model which includes risk- and protective factors to describe the coping process with the illness will be developed. Subsequently, the importance of implementing routine psychological screening is emphasized. Although in the…meanwhile psycho-oncological support is an integral part of multidisciplinary treatment, there are only few effectiveness studies in this field. In addition, it remains unclear how the psycho-oncological follow-up and the transition to adult-care should be designed and thus conclusions for future directions are drawn.
Keywords: coping with the disease, cancer, child and adolescent, psycho-oncology
Abstract: Pediatric headaches, namely migraine and tension type headache, belong to the most common health problems in children and adolescents. The behavioural medicine approach to chronic headache in childhood and adolescence is based on the etiopathogenesis and empirical research. The biobehavioral perspective has the concept of migraine as an information processing deficit disorder, characterized by a central hypersensitivity (informationprocessing dysfunction) and dishabituation. We assume that hereditary and psychosocial (parental education) mechanisms both play…an important role in migraine. Behavioural medicine interventions are highly effective and encompass information-processing-training, stress-management training, relaxation training, pain-coping techniques and biofeedback treatment.
Keywords: Migraine, headaches, behavioural medicine, disturbed cortical information processing
Abstract: Three percent of children and adolescents in Germany have short stature (SS) which also includes patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS). Growth hormone substitution in these patients is expected to increase height, health-related quality of life (HrQoL) and mental health. The present cross-sectional study investigated healthrelated quality of life and mental health of children with SS in comparison to a representative German population sample and examined differences within…patients with respect to treatment status, diagnosis and actual height. A total of 143 patients (4–18 years) and their parents completed questionnaires for mental health (SDQ) and health-related quality of life (KIDSCREEN-52). Results showed that children and adolescents with short stature report significant HrQoL impairments in comparison to children with normal height, while differences in mental health were apparent at specific subscale levels. Within the clinical sample, no differences regarding age and gender were detected. Also, no significant differences in HrQoL and mental health were found according to diagnosis (GHD/ISS), treatment status and actual height. Parents rated their childrens' HrQoL higher than the children themselves, whereas they considered their children' psychological health problems more serious than the children themselves did. Results suggest that SS is associated with impairments in HrQol and mental health as compared to a population reference group, suggesting that these impairments should be addressed with condition-specific interventions. Generic tools such as KIDSCREEN did not yield differences within the patient group regarding clinical and socio-demographic characteristics. Clinical studies therefore should consider making use of condition specific measures.
Keywords: Short stature, growth hormone deficiency, idiopathic short stature, quality of life, children