Program considerations in comprehensive care of chronically ill children.
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Biomedical subjects
Publications and source records attributed to B Stabler.
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To examine the hypothesis that the degree of maternal compliance with physical therapy regimens for cystic fibrosis (CF) is correlated with the child's psychological adjustment, compliance was classified by independent raters as "moderate" (intermediate) or "unmoderated" (rigid adherence or clear noncompliance). Compliance data were obtained in a structured self-report interview. The Piers-Harris Children's Self-Concept Scale was administered to the children (23 boys, aged 7-15 years) to measure this dimension of psychological adjustment. Children of mothers with unmoderated compliance scored significantly lower on total self-concept scores and on subtests measuring popularity and physical appearance and attributes than those with mothers whose compliance was rated as moderated. These findings, if confirmed in studies with larger samples that include girls with CF, have implications for practitioners who treat children with this disorder.
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Thirty-five elementary school children received the WISC, Rorschach, CAT, and Sentence Completion Test in counterbalanced order with a test-test interval of approximately 24 hours. State and trait anxiety measures were assessed immediately prior to and immediately following each test administration. Results indicated that state anxiety measures increased significantly following administration of the more ambigious and school related assessment tests, namely the Rorschach and WISC. In contrast, the more structured, less amorphous CAT and Sentence Completion Test, did not induce any significant changes in state anxiety. In all cases, trait anxiety measures remained relatively stable. Implications for assessment techniques with children were discussed.
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We studied the relationship between presence of Type A behavior pattern and glycemic response to stress in children with insulin dependent diabetes mellitus (IDDM). Twelve male (six Type A and six Type B) and nine female (four Type A and five Type B) insulin-dependent diabetic patients between the ages of 8 and 16 years received a standard meal and blood glucose values were assessed two hours later. All subjects then played a competitive videogame for 10 minutes following which blood glucose was assessed again. Preprandial and postprandial blood glucose values did not differ between the groups. However, only Type A subjects showed a hyperglycemic response to the videogame stress. Type A subjects also demonstrated significantly higher glycohemoglobin values. In order to assure that this effect was due to a differential response to stress and not simply a difference in metabolic response to a meal, a second study was conducted in which blood glucose values were assessed at one, two and three hours following a standard meal. No significant differences in postprandial blood glucose values were observed between Type A and Type B subjects. These data support previous research which has suggested that some but not all patients with IDDM show a hyperglycemic response to stress.
OBJECTIVE: We have reported high rates of social phobia in growth hormone-deficient (GHD) adults who had been treated with growth hormone during childhood. This follow-up study was conducted to determine whether the increased social phobia observed in GHD subjects was secondary to the effects of short stature. METHODS: Twenty-one age- and sex-matched non-GHD short adults were evaluated for social anxiety and compared with the previously studied 21 GHD subjects. RESULTS: Thirty-eight percent (8 of 21) of GHD and 10% (2 of 21) of short subjects met DSM-III-R criteria for social phobia. GHD subjected scored significantly higher than short subjects on the following self-report questionnaires: Fear of Negative Evaluation (p = .03), Fear Questionnaire (p = .01), Social Avoidance and Distress Scale (p = .01), Beck Depression Inventory (p = .007), and the Tridimensional Personality Questionnaire-harm avoidance subscale (p = .0004). CONCLUSIONS: These data suggest that the high prevalence of social phobia in GHD adults is not explained by short stature alone.
Separation and loss issues arise frequently in pediatric hospital settings. Three forms of psychiatry/psychology liaison are presented which demonstrate: 1. case-centered collaboration to address child and family concerns about death; 2. team-centered activities which link family and staff roles in the course of terminal illness; and 3. the development of a program mechanism to meet the needs of staff "survivors" of recurrent childhood deaths. These examples illustrate the enrichment which pediatric psychiatry/psychology liaison program offer when the conceptual model of liaison service and teaching operates flexibly on case, team, and program levels.
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