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Chapter Thirteen

Chapter Thirteen. DEVELOPMENTAL CONSEQUENCES OF BRAIN INJURIES AND CHRONIC ILLNESS Developmental Psychopathology: From Infancy through Adolescence, 5 th edition By Charles Wenar and Patricia Kerig.

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Chapter Thirteen

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  1. Chapter Thirteen DEVELOPMENTAL CONSEQUENCES OF BRAIN INJURIES AND CHRONIC ILLNESS Developmental Psychopathology: From Infancy through Adolescence, 5th edition By Charles Wenar and Patricia Kerig

  2. Field of pediatric psychology (behavioral medicine) allows psychologists to specialize in working with children who face variety of medical issues • Our exploration of the intersection between medical issues and psychology includes both Chronic Illness and Brain Damage

  3. BRAIN DAMAGE Three definitions of BRAIN DAMAGE: • neurological • behavioral • etiological

  4. Psychopathology and Brain Damage • Although brain damage increases risk for psychological disturbance, research indicates that only when biological factors result in major brain disorders is risk of psychopathology significantly increased • Functions most powerfully affected by brain damage are cognition, sensory and motor operations, and seizure sensitivity

  5. Assessment • neurological examination • neuroimaging techniques • electroencephalogram (EEG) • computerized axial tomography (CAT) scans • magnetic resonance imaging (MRI) • functional magnetic resonance imagery (FMRI) • position-emission tomography (PET scans) • neuropsychological testing

  6. Traumatic Brain Injury (TBI) • Traumatic Brain Injury (TBI): “an acquired injury to the brain caused by external physical force resulting in . . . functional disability or psychological impairment” • Two Types of TBI: • penetrating head injury • closed head injury

  7. Characteristics of TBI • prevalence • gender • SES • ethnicity • age • developmental course

  8. TBI and Psychopathology • preinjury (“premorbid”) functioning • psychopathology postinjury

  9. Etiology of TBI • Biological Context • physical effects • biochemical changes • secondary brain damage • Individual Context • cognitive development (intelligence, attention, language, memory, motor and sensory, executive function) • emotional development • self • Family Context • Social Context

  10. Intervention for TBI • Interventions for TBI must be diverse owing to variable and multifaceted effects of injuries • In addition to collaboration among medical staff, family and school, cognitive rehabilitation with the child may involve: • careful assessment • analyzing and restructuring child’s daily routine • provide visual prompts to help child stay organized • rehearsing steps

  11. CHRONIC ILLNESS • Pediatric psychologists view both sickness and health as resulting from interplay of biological, psychological, social, and cultural factors • Illnesses may have different effects, depending on person’s age, as challenges of the illness interact with specific stage-salient issues of development

  12. chronic vs. acute illness • prevalence of chronic illness • common chronic illnesses of childhood: • asthma • cystic fibrosis • cerebral palsy • diabetes mellitus • sickle cell disease • juvenile rheumatoid arthritis • cancer

  13. “Prevalence of Childhood Chronic Illness”

  14. Chronic Illness and Psychopathology • Not all children with chronic illness develop psychopathological disturbance, but their risk is increased • Depression and anxiety are particularly common • Medical conditions may be listed on Axis III using DSM-IV-TR system

  15. Clinician may also consider Axis I diagnosis of Psychological Factors Affecting a Medical Condition • This diagnosis reflects presence of psychological, behavioral, or sociocultural factors that negatively affect the course or treatment of a medical condition

  16. Features of DSM-IV-TR Psychological Factors Affecting Medical Condition • Presence of medical condition • Psychological factors adversely affecting medical condition in one of the following ways: • timing of factors suggests an association with medical condition • factors interfere with treatment • factors constitute additional health risks • stress-related responses precipitate or exacerbate symptoms of medical condition

  17. “Factors” may include: • mental disorder • subclinical symptoms • personality traits or coping styles • maladaptive health behaviors • stress-related responses

  18. Etiology of Chronic Illness • Biological Context • Social Context • Individual Context • cognitive development (illness and pain) • Family Context • parental effects on children’s adjustment • parenting stress • parental adjustment • social support

  19. Intervention for Chronic Illness-Related Problems Psychotherapeutic interventions for children vary according to effects of the disorder and comorbid psychopathologies that accompany it • Family Systems Pediatric Interventions • Coping with Pain • procedure-related pain • parent inclusion

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