Mark Scott Smith

Factors related to school absenteeism in adolescents with recurrent headache.

Objective.—To examine possible risk and protective factors for school absenteeism among adolescents referred to a hospital‐based behavioral treatment program.

Recurrent Headache in Adolescents: Nonreferred Versus Clinic Population

Objective.—To compare headache activity, psychosocial measures, and cold pressor response between referred and nonreferred adolescents with frequent headache.

Psychosocial functioning, life change, and clinical status in adolescents with cystic fibrosis

Twenty-six adolescents with cystic fibrosis (CF) were administered the Tennessee Self Concept Scale. The mean overall scores placed the CF patients at the 30th percentile of a normative adolescent population. Eighty-five percent were at appropriate school grade level, 69% participated in physical education classes, and 81% had future plans for college and/or a career. Total Life Event scores of CF adolescents were not significantly different from the normal adolescent population. However, in 22 CF adolescents evaluated with a modified National Institute of Health Scoring System, negative Life Event scores were higher in 10 adolescents with moderate to severely impaired health status than in 12 with lesser impairment. This relationship was not modified by other psychosocial variables.

Stress Management Techniques in Childhood and Adolescence Relaxation Training, Meditation, Hypnosis, and Biofeedback: Appropriate Clinical Applications

Many childhood and adolescent stress-related symptoms have a psychophysiological component that involves muscular tension and/or autonomic nervous system dysfunction. Examples of this include recurrent headache, chest pain, abdominal pain, syncope, and dizziness. After a careful medical and psychosocial evaluation, the clinician may identify many patients who are appropriate for the application of stress reduction techniques such as progressive muscular relaxation, meditation, biofeedback, and relaxation/mental imagery (self-hypnosis). This review describes these techniques and their application with selected children and adolescents.

Behavioral management of childhood headache: a pilot study and case history report

Many chronically recurrent disorders of children and adolescents are often unresponsive to standard medical therapy. The Stress and Headache Management Clinic was established as a prototype behavioral medicine clinic to provide integrated therapeutic modalities. Using biofeedback and relaxation/mental-imagery techniques, 119 patients with the chief complaint of recurrent headache were evaluated. This paper describes the use, application, and efficacy of behavioral techniques for the management of headache in children and adolescents. Relevant treatment factors in behavioral treatment of pediatric headache are also discussed.

Organic Diseases Mimicking Atypical Eating Disorders

The authors present three case studies of patients referred to Childrens Hospital and Medical Center, Seattle, Washington, for evaluation of possible eating disorders. The atypical manifestations of the cases warranted further investigation, which revealed an organic basis for their weight loss. The authors summarize the typical findings of bulimia and anorexia nervosa and discuss the clues from the case studies that mandated further evaluation.

Perceived Anxiety of Pediatric Patients to Magnetic Resonance

Magnetic resonance imaging (MRI), a nonionizing radiologic technique without known adverse physical effects, is utilized frequently in children and adolescents. The MRI technique requires prolonged immobility in a narrow, confined space, and concern has been raised regarding possible patient anxiety and noncompliance. Several reports suggest that up to 10% of adults undergoing MRI may experience anxiety and/or claustrophobia. 1 However, to our knowledge, no studies of the subjective MRI experiences of children and adolescents have been published. We report here the general characteristics of 491 consecutive Pediatric patients who were evaluated with MRI at our institution, including the experience of anxiety in 85 older children and adolescents.

Anxiety and depression in the behavioral treatment of headache in children and adolescents.

Controlled studies have demonstrated that behavioral techniques are effective in the treatment of recurrent pediatric headache. The outcome of therapy may be influenced by factors that are intrinsic to the patient. We have reviewed the existing headache literature with particular emphasis on anxiety and depression and examined patient factors in our own series of 119 children and adolescents treated with biofeedback and relaxation-mental imagery. Patients with tension headache had significantly higher intake anxiety and depression scores than migraine or mixed headache patients. Anxiety and depression scores were significantly decreased from intake to end of treatment. Headache activity at the end of treatment was not significantly related to age, sex, headache type, hypnotizability or number of treatment sessions. Patients with higher intake anxiety scores had better clinical outcomes than those with lower scores. Intake depression scores showed no correlation with clinical outcome.

Psychosomatic symptoms in adolescence

This article provides the physician with an efficient and comprehensive method for the evaluation and management of adolescent psychosomatic symptoms in the medical care setting. The physician should make a firm statement of the nonorganic nature of the psychosomatic symptom, identify significant stressors, and provide strong recommendations for immediate action. Appropriate referrals should be arranged, and a follow-up visit to assess progress several weeks after the evaluation should be scheduled.

Evaluation and Management of Psychosomatic Symptoms in Adolescence

Adolescent patients commonly experience symptoms such as headache, chest pain, abdominal pain, or dizziness that are psychophysiologic responses to stress, anxiety, and depression. Because most symptomatic adolescents initially visit medical providers, and not mental health professionals, the clinician is faced with the challenge of providing a comprehensive evaluation that is not merely focused on the symptom. In addition to a careful medical assessment, this evaluation must include a review of psychosocial functioning in the family, school, peer group, and community. Appropriate management may include supportive counseling, instruction in relaxation techniques, anti-depressant medication, and referral for psychotherapy.