Roberta A. Olson

Behavioral management of children's distress during painful medical procedures

Abstract The purpose of the current study was to develop and assess the efficacy of a psychological intervention program to reduce the behavioral distress of pediatric cancer patients undergoing highly-painful medical procedures (bone-marrow aspirations and lumbar punctures) which are required for the diagnosis and treatment of their disease. The psychological intervention was delivered to 5 patients ages 3 1 2 –7yr within the context of a staggered baseline design. Results suggested that the program was effective at reducing behavioral distress for all 5 patients during the initial intervention. However, 1 S showed some regression of intervention effects during a second treatment session. Possible alternative explanations for the results obtained were discussed and implications for future research were presented.

The management of children's distress in response to painful medical treatment for burn injuries ☆

Abstract The purpose of the current study was to develop an initial assessment of the efficacy of astress-management program designed to reduce the behavioral distress of children undergoing highlypainful medical treatments for their burn injuries. The stress-management program was delivered to 4 male patients, ages 5–12 yr and its effects assessed in a combined multiple-baseline and reversal design. Results indicated that the program was moderately effective at reducing behavioral distress during the burntreatment procedures for 3 of the 4 patients and less effective with the fourth. However, the design also revealed that the presence of a therapist to coach the patient in the use of these techniques was essential and that distress levels rose substantially on days when there was no therapist present. Finally, speculations concerning the factors responsible for the effectiveness of the stress-management program as well as its reduced efficacy with 1 S were discussed.

Same-Day Surgery Preparation: Reduction of Pediatric Patient Arousal and Distress through Participant Modeling.

Twenty-six children (mean age = 5.5 years) were exposed to one of three surgery preparatory conditions: participant modeling alone (n = 9), participant modeling with mother (n = 8), and standard procedure control (n = 9). Children exposed to the modeling slide-tape without their mothers had significant reductions in physiological arousal after the slide-tape presentation, unlike children viewing the tape with their mothers and children exposed to the control condition. Both participant modeling groups exhibited significantly fewer distressful behaviors during recovery (postsurgery) than did control group children. Results are discussed with respect to previous medical preparation research. Implications of these findings concerning clinical application and future research are addressed.

Self-regulation treatment to reduce the aversiveness of cancer chemotherapy

In an A-B design, the effectiveness of a multicomponent intervention for reducing chemotherapy-associated nausea and emesis in an 11-year-old cancer patient was evaluated. A highly structured, time-limited, self-regulation treatment was implemented that consisted of patient and parent instruction in self-hypnotic methods, cue-controlled relaxation, and guided imagery. Practice of the self-regulation methods at home and in vivo (clinic setting) in the absence of chemotherapy infusion were emphasized to promote skill acquisition and cross-setting generalization. Dependent variables included self-reported nausea intensity and parental report of duration of the patients sleep and vomiting frequency. Data were obtained before, during, and following chemotherapy for baseline and self-regulation treatment phases across five cycles of chemotherapy that occurred over a 5-month period. During the intervention phase, a marked and clinically significant reduction in self-reported nausea and parent-observed vomiting were noted as well as a concurrent increase in sleep duration. The integrity of patient self-report and parental observations were supported by clinic staff anecdotal data. Treatment limitations and cost-effectiveness are discussed as well as the use of this intervention with adolescent patients.

Compliance With Treatment Regimens

Abstract Adolescent noncompliance with medication is a significant problem. Bioassays for the assessment of noncompliance with some drugs used in the treatment of cancer have only recently been introduced. 5 Further research is still needed. Educational, behavioral, and family systems interventions have been found to be successful with adolescents with cancer or other chronic illnesses. Awareness of the potential for noncompliance is essential to the health care and treatment of adolescent oncology patients.

Medical Adherence in Pediatric Populations

Adherence to medication or medical regimes is considered the major factor in obtaining a successful outcome of therapy. In order to adequately assess the effectiveness of a medical intervention, it is necessary to obtain adherence to the prescribed regime. Nonadherence to a prescribed treatment can lead to increased patient visits, emergency care, and over prescribing of medications. Nonadherence may eventually result in a failure to obtain a therapeutic outcome (Becker & Green, 1975), including progression of the disease (Stewart & Cluff, 1977), recurrent infections (Daschner & Marget, 1975), and emergence of resistant infections (Rapoff & Christopherson, 1982).

Psychological Consultation in a Children’s Hospital

Relatively few studies have examined the types of patients seen and services provided by pediatric psychologists in clinical settings. Even fewer studies have provided a program evaluation of these services. Kanoy and Schroeder (1985) examined referrals received from a “Call In/Come In” service from a private pediatric group, whereas Ottinger and Roberts (1980) surveyed referrals from pediatricians to a pediatric psychology practicum. Walker (1979) examined both inpatient and outpatient referrals from a large children’s hospital. A relatively consistent pattern of results was obtained across the three settings. The most frequent referrals were for negative behaviors, developmental delays, psychosomatic problems, school problems, and toileting problems. Pediatric psychologists in each setting also received a smaller number of referrals for problems associated with acute and chronic medical illnesses and developmental problems in childhood and adolescence.

Pediatric AIDS/HIV Infection

Pediatric acquired immunodeficiency syndrome (AIDS) is a disease with social and political ramifications that affect both research and psychotherapy with children and families. This paper examines selected clinical and ethical issues psychologists may encounter in research or psychotherapy with children, adolescents, or parents who are positive for the human immunodeficiency virus (HIV) antibody or have AIDS. A brief overview of AIDS-related research and future directions is presented with particular relevance to pediatric psychology.