Adolph E. Christ

Current Approaches to Helping Children Cope with a Parent's Terminal Illness

Much has been learned about childhood bereavement in the last few decades as studies have increasingly focused on the direct interviewing of children about their recovery from the tragic loss of a parent. It has been shown that children do indeed mourn, although differently from adults. Important moderating and mediating variables have been identified that impact their recovery from the loss of a parent, which can be the focus of intervention. When death is expected, the terminal phase of an illness has been found to be particularly stressful for children, yet seldom investigated. Similarly, few studies have explored the impact of development on childrens experience and expression of grief. We present research findings that clarify phases in childrens experience during the terminal illness, hospital visits, the death, and its immediate aftermath, as well as how the parent is mourned and issues in longer term reconstitution. Variations in childrens responses in these phases are described as they were experienced by 87 children from 3 different developmental groupings: 3 to 5 years, 6 to 8 years, and 9 to 11 years. Recommendations are suggested for parents and professionals about ways to understand and support children during the terminal illness, at the time of death, and during the phase of reconstitution.

Childhood Disorder Diagnosis‐Related Group: Viability in a Prospective Payment System

Abstract Accounting for length of stay using diagnosis‐related groups (DRGs) is relatively effective for medical, but not psychiatric, patients. The single official childhood disorder (DRG with a geometric mean of 6.6 days is not representative of values obtained in this and other studies. The authors explore the possibility that traditional medicare variables can be used to develop a set of childhood disorder DRGs. Seven groups of demographic and diagnosis‐related variables predicted only 10.2% of the variance in length of stay of 1,561 children admitted to the child/adolescent psychiatric wards of a general hospital. This is inadequate for the development of alternative childhood disorder DRGs, each with a more meaningful mean length of stay. Directions for future research are discussed.

Relationship of Auditory and Visual Skills to Reading Retardation

The relationship between specific tests of auditory and visual skills and phonic decoding, sight-word reading, and comprehension was investigated in a sample of 77 poor readers from a racially and ethnically heterogeneous elementary school population in New York City. Partial correlational analyses (with age and IQ as control variables) indicated that only two of the skill measures (Auditory Closure and Sound Blending) related to a wide variety of reading measures independently of IQ. Results also showed that IQ scores did not correlate highly with the reading measures. It is concluded that the findings do not support the hypothesis that children can be successfully sorted into auditory and visual learner categories on the basis of the instruments employed (aptitude-treatment interaction). Furthermore, the results suggest that the use of IQ scores to compute expected reading levels for children is questionable.

Psychotherapy of the Child with True Brain Damage.

Psychotherapy of the child with true brain damage presents special problems and requires special approaches. Those who are cognitively primitive--at the sensorimotor or preoperational stage of development--require a crisis approach; those at the concrete or formal operational stage can be treated with a modified insight-oriented approach. Development of a therapeutic alliance, establishment of workable defense mechanisms, identification and clarification of unalterable cognitive defects and issues of termination unique to this special population are discussed.

Cognitive Assessment of the Psychotic Child: A Piagetian Framework

Abstract Piagets concepts of cognitive stages provide a useful framework for the evaluation of cognitive organization of severely disturbed children. This cognitive developmental perspective complements the psychosexual developmental sequence and the traditional emphasis on the underlying emotional dynamics. A combined use of these frameworks helps to formulate various ways of dealing with behavioral deviations, whether they originate in the child, the family, the teacher, or the school situation. The consulting child psychiatrist serves to synthesize the several perspectives in order to help the teacher develop teaching strategies and tactics consistent with the childs cognitive competence.

The Challenge of Pediatric Medical Illness to Family Theory and Family Therapy

What are the challenges that medical illness brings to the mental health profession? A number will emerge in the chapters that follow. The one I would like to emphasize is: Can we reorient our perspective and deal with those problems in the family with a medically ill child that might require us to alter our basic psychiatric perspectives, theories, and therapies, rather than, as we have in the past, with the applications of our theories and expertise to the physically ill child and his family?

Evidence of incomplete cortical modulation of autonomic responses in 11-to 16-year-old adolescents

This study examines response differentiation in the sympathetically innervated skin conductance response (SCR). Differentiation in such systems has been ascribed to cortical inhibitory control over subcortical autonomic centers. Developmental study of such differentiation thus provides information on cortical development and the maturation of cortical control over subcortical centers. Previous investigators have focused on the simple level of differentiation involved in discriminating response on one side the body from that on the other. In such studies several investigators reported more diffuse response among young children; some reported adultlike differentiation by approximately age 10. The present study examines a more complex instance of differentiation, the quantitative modulation of response from a given site in order to produce SCR amplitudes proportionate to the information value of the eliciting stimulus. Relatively large amplitude SCRs elicited by imperative PRESS-SIGNALS of varying information value were studied, together with smaller SCRs elicited by NONPRESS-SIGNALS also varying in information value, in two adolescent groups, aged 11–16 years, and in a young adult sample. In contrast to earlier work, the present study demonstrates a continuing difference between adolescents and adults. Adults showed consistent differentiation, with SCR amplitude reflecting changes in stimulus information values for both PRESS- and NONPRESS-SIGNALS. Adolescents displayed differentiation only for SCRs elicited by NONPRESS-SIGNALS: Response to PRESS-SIGNALS did not reflect stimulus information values, even though reaction time data demonstrated that PRESS-SIGNAL information was being registered cortically. The degree of cortical control present in these adolescents, enabling them to display differentiated SCRs to NONPRESS-SIGNALS, would likely be sufficient to allow simple left-right discrimination, perhaps accounting for the “adultlike” reactions previously reported for this age group. The inability of the adolescents to sustain SCR differentiation when large amplitude responses were elicited by the PRESS-SIGNALS might reflect the inability of still immature cortical controls to cope with sizable sympathetic output. A “critical level” of sympathetic “arousal” may exist for adolescents in this age range, above which cortical inhibitory controls may become ineffective.

Introduction: Psychosocial Challenges in Childhood Cancer

There are three challenges that children and adolescents with cancer present to the mental health and oncology professions, challenges that prompted us to invite a panel of distinguished contributors to this third symposium on family therapy.

Psychological Issues and Future Directions: General Discussion

The following is an edited transcript of the presenter-audience question-answer and round table discussions.

Complexity of Cancer Etiologies: Panel Discussion

I want to tell you of the image I had when Dr. Miller spoke of the mice. I can’t imagine the mouse in the maze with gridlock. The stresses will never be quite comparable to New York City!