Acute and chronic physical illnesses are stressful for children and their families. The stresses of physical illness manifest as psychological reactions involving somatic symptoms (e.g., pain, dizziness, or fatigue), behavioral changes (e.g., acting out, nonadherence, or lifestyle alterations), emotional states (e.g., fear, sadness, or anxiety), and developmental challenges (e.g., incorporating medical information at different developmental stages). This chapter provides an overview of psychological reactions to physical illness, a differential diagnosis approach to these reactions, a review of selected childhood physical illnesses, and a summary of mental health interventions in children with physical illnesses.
Between 10 and 20 million U.S. children have a chronic physical illness or medical condition that significantly affects their functioning and life during at least 3 months of the year (American Psychiatric Association, 2000). Although children and their families are overall remarkably resilient in adapting to the challenges presented by a physical illness, at least 10% of children with physical illness have symptoms severe enough to have an impact on their daily living (Ingerski et al, 2010). With the advent of successful medical/surgical management for many childhood illnesses, pediatric psychosomatic medicine (including consultation–liaison psychiatry, pediatric psychology, and behavioral medicine) has developed as a specialty supporting children and their families with the emotional and behavioral impacts of acute and chronic systemic illness via psychological and pharmacological treatments (Bujoreanu et al, 2015; Snell & DeMaso, 2010).
Reactions to illness cover a spectrum of emotions and behaviors, from simple verbal expressions of discomfort, crying, or temporary withdrawal to disabling responses involving significant regression in social and emotional functioning (e.g., anxiety, depression, oppositional behaviors, or nonadherence). It is important to highlight that labeling a reaction as "normal" or "abnormal" is dependent not only on a child's developmental stage, but also on whose perspective is being considered. For example, parents and children are more focused on minimizing distress (hence withdrawal, unresponsiveness, or resistance), as compared to providers, who are often more interested in maximizing adherence to treatment (Rudolph et al, 1995). Furthermore, particularly for children with chronic physical conditions, past negative medical experiences are likely to increase a child's emotional distress during subsequent health care encounters (Siegel & Smith, 1989), and previous hospitalizations can lead to more troubling increases in separation anxiety, sleep difficulties, and pain perception, as well as changes in physiological indicators (Thompson, 1986).
DIFFERENTIAL DIAGNOSIS APPROACH TO PSYCHOLOGICAL REACTIONS IN PHYSICAL ILLNESS
In the classic dichotomy, psychological reactions can be classified as internalizing or externalizing, depending on how the emotional tension is experienced by the child and the people around him/her. Depression, anxiety, and somatic complaints are markers of internalizing problems, whereas behavioral "acting out," aggression, or hyperactivity are typical symptoms of externalizing problems. For physically ill children, internalizing symptoms are the most frequently occurring presentation (Pinquart & Shen, 2011) and appear to be more frequent than in physically healthy children (Barlow & ...