Stanford B. Friedman

Urinary 17-hydroxycorticosteroid levels in parents of children with neoplastic disease

&NA; Urinary 17‐hydroxycorticosteroid (17‐OHCS) excretion rates were determined in 43 subjects, representing one or both parents of 26 children with neoplastic disease. Twentynine of the parents were admitted for study to a National Institute of Mental Health ward while their children were hospitalized; 14 parents lived at home and were studied on an “outpatient” basis. In this situation of chronic psychological stress, repeated determinations on each parent showed that the 17‐OHCS level tended to remain within a relatively constricted range, even when the parent was exposed to superimposed acute stress. The subjects were ranked according to their relative corticosteroid excretion rates, and adrenal cortical activity was hypothesized to be related to the effectiveness of the individuals coping behavior. The group data showed slight, but statistically significant, elevations at the time the parents were first admitted to the ward and when psychological stress was judged to be maximal. A statistically significant sex difference was observed, with mean values for the fathers and mothers of 7.3lmg./24 hr. and 5.0 mg./24 hr., respectively.

Conversion Symptoms in Adolescents

The diagnosis of conversion symptoms, common in adolescents, depends upon eliciting a pattern of behavior and symptomatology characteristic of conversion reactions, and not merely excluding an organic cause. Conversion symptoms may be seen as a form of communication in which the patient is expressing an unconscious wish or thought. The nature of the symptom has been found to have specific symbolic meaning to the patient. Many cases can be appropriately managed by the physician who takes an interest in the emotional problems of his patient and is willing to develop basic psychiatric skills.

Psychological Aspects of Sudden Unexpected Death in Infants and Children

The sudden unexpected death of a child is a tragic event, necessitating long-term psychological adaptation for parents and siblings. Death occurring during the newborn period presents special problems. The physician must view unexpected death as the beginning of a family crisis, and realize that his role may extend far beyond the period immediately after death.

Parent Interview Findings Regarding the Impact of Cystic Fibrosis on Families.

An assessment of the impact of cystic fibrosis (CF) was conducted with 43 families. Semistructured parental interviews on family functioning, parent-child interactions, sibling and peer relationships, and medical issues were coded by two independent raters to identify “major,” “minor”, or “no” problems. Of the 62 questions presented, only 8 were viewed by more than 10% of parents as “major problems.” The impact of hospitalization upon parents was the most prevalent “major problem.” Parental communication was a “major problem” for 28% of the mothers but for only one father. Ten to 15% of the parents described “major problems” related to: their marital relationship, accepting the illness, feeling they should do more for their child with CF, feeling their other children had been deprived or complained about inattention, or their relationship with the ill childs grandparents. While most families were generally coping successfully, health care professionals should be alert to specific areas of potential problems.

Marfan syndrome in adolescents and young adults: psychosocial functioning and knowledge.

Twenty-two subjects with Marfan syndrome (age range 11–24 years, mean 15.7 years) were studied to evaluate the impact of Marfan syndrome on their lives, level of psychosocial adaptation, concerns about their disorder, compliance with medical regimens, and knowledge of Marfan syndrome. Subjects were interviewed and then completed the Offer Self-Image Questionnaire and two questionnaires designed for the study. Parents also were interviewed. Subjects demonstrated normal psychosocial adaptation on the Offer Self-Image Questionnaire. Nevertheless, the subjects perceived that their lives would be significantly better without Marfan syndrome, especially in the areas of physical activities and self-image. They expressed concerns about their illness most often to their parents, less frequently to their doctors. Their compliance with medical regimens were suboptimal and similar to the published description of compliance among teenagers with other chronic illnesses. Their knowledge base was weakest in the areas pertaining to future childbearing. Thus, althogh these subjects showed normal psychosocial adaptation, doctors caring for them may foster bette coping with Marfan syndrome by discussing self-image issues and Marfan syndrome-related concerns, and by encouraging compliance and imparting knowledge. J Dev Behav Pediatr 11:122–127, 1990. Index terms: Marfan syndrome, adolescents, psychosocial adaptation, medical compliance, chronic illness.

Behavioral Considerations in the Health Care of Adolescents

The interrelated physical and psychological development of adolescence is an important factor in the evaluation and care of young people. A discussion of psychological growth and development is presented, followed by guidelines on interviewing the adolescent, a discussion of the psychological considerations of the physical examination, an approach to referring adolescents for psychological problems, and an analysis of physician traits that are essential for the efficacious care of adolescents.

The Pediatrician in an Innovative Public School Health Program One Future Focus for Pediatrics

A three-year experience with the pupil-personnel-medical team approach to health problems in a suburban elementary school has been viewed as successful by both the participating school district and the department of pediatrics, and may be one model for cooperative efforts between education and medicine.

Out of control behavior in adolescents

The physician should approach a problem of out of control behavior in an adolescent as a family issue rather than an individual issue, for not only the behavior itself bu the parental response to the behavior are key factors in understanding and coping with it. Areas of commonly encountered misbehavior are explored.

Coping with a Chronic Disability: Psychosocial Observations of Girls with Scoliosis

The psychosocial implications of wearing the Milwaukee brace for scoliosis have been commented upon by orthopedic surgeons. Riseborough1 summarizes: “Patients adapt to the brace rapidly, but the initial experience may provoke an emotional storm.” Harrington2 points out that a major alteration in daily living is involved and that patient-parent cooperation is critical for successful treatment. He groups brace wearers into three types: (1) brace riders (who develop ulcers on the chin and avoid exercises), (2) habit formers (who twist their necks and hence avoid the therapeutic forces of the brace), and (3) ideal patients. This paper represents a more detailed examination of how adolescent girls and their mothers psychologically adjust to the girl having to wear a Milwaukee brace.

Management of Infants with Apnea and Potential Apnea A Survey of Pediatric Opinion

Conflicting opinions and inadequate data have led to confusion regarding the relationship of sudden infant death syndrome (SIDS) and infantile apnea. Consensus regarding appropriate eval uation and management strategies for infants presumed at risk has not been reached. This study surveyed pediatric opinion regarding these issues. Questionnaires were mailed to 1000 randomly selected members of the American Academy of Pediatrics, and to faculty at all approved U.S. pediatric residency programs. Results indicated that respondents as a group were uncertain about the relationship between SIDS and apnea. Most respondents would (1) initially evaluate infants presenting with apnea at either a hospital or an apnea evaluation center, (2) refer subsequent siblings of SIDS infants to an apnea center, and (3) recommend no intervention, but provide reassurance, to anxious parents requesting a test for SIDS for a normal newborn. Respondents comments showed diverse opinions regarding appropriate evaluation and management strategies for these three types of infants, and reflected concern regarding dilemmas posed to clinicians responsible for their care. Further research and continuing medical education efforts are needed to reduce current confusion.