Paediatric Psychology & Talking to Children About Illness

• Beliefs about the helping process can influence the outcome of referral and treatment.
• "Transference" refers to patterns of relationships in interaction with a hospital therapeutic team.
• Clinical observations reveal clients engage with services through passive attachment, expecting idealized solutions, hostile rejection, or feeling the team is failing them.
• A history of sexual abuse in childhood can prevent individuals from seeking or accessing treatment.
• A systemic approach emphasizes that context gives meaning to behavior.

Talking to Children About Illness

• Communication with children about illness should be tailored to their developmental stage.
• Children aged 0-3 won't understand illness but require basic needs addressed with simple language.

Paediatric Psychology

• Mental health and physical health are intertwined.
• "No health without mental health" highlights the inseparability of mental and physical well-being.
• The NHS long-term plan emphasizes valuing mental health equally with physical health.
• The National Service Framework for Children in Hospital (2004) aims to help children with long-term conditions experience an ordinary life.
• 10-30% of children are affected by chronic illness or physical health problems.
• Chronic illness impacts the emotional, social, and cognitive development of young people, their families, and their schooling.
• Children with illnesses are at increased risk of developing mental health problems, though many cope well.
• 3 in 4 children and young people (CYP) with mental illness also have a physical health or developmental problem.
• Having a physical illness increases the chances of having a mental illness by 82%.

Paediatric Psychology Settings

• Inpatient: wards
• Outpatient: medical clinic or separate psychology appointments.
• Paediatric psychologists may be attached to a medical specialty or work in a generalized role.
• They work with young people and their families and liaise with local services.
• Pediatric psychologists consult, debrief, teach, and train staff groups and teams on topics like talking about death and dying or self-care.
• Some community services are based in Child and Adolescent Mental Health Services (CAMHS) rather than hospitals.

Referral Themes

• Providing education and information about health conditions, including naming the condition.
• Addressing adjustment and living alongside conditions, including dealing with uncertainty and restrictions.
• Managing procedural anxiety, such as fear of needles, through exposure work.
• Addressing visible differences and body image concerns.
• Improving adherence to treatment, noting that adherence is estimated at 50%.
• Facilitating peer relationships and socialization, including how to talk to friends about a condition.
• Addressing cognitive difficulties.
• Providing support with loss and grief.
• Supporting teams to make sense of experiences through debriefs and discussions.
• Addressing "perplexing presentations" like medically unexplained symptoms (MUS) or functional presentations.

Functional Presentations

• Physical symptoms lack an obvious physical cause
• Sometimes there are underlying physical health conditions with a ‘functional overlay’.
• Current pathways often discharge patients with functional diagnoses and reject them from CAMHS services.

Impact of Functional Presentations

• Increased stress on the family.
• Impact on siblings.
• Missing school and peers.
• Missed normal activities.
• Experiencing treatment effects and adhering to treatment regimens.
• Medical trauma.
• Interference with developmental milestones.

Responding to Referrals

• Consider the characteristics of the illness, disability, or treatment, including the nature of the treatment (time-consuming, complex, uncomfortable, scary).
• Consider rarity, visibility, stigma, course, outcome, degree of uncertainty, and aetiology.
• Begin by speaking to the referrer and family to understand their readiness for help.
• Normalization is very important when responding to referrals.
• Reactions are normal, and it’s natural to feel distressed in response to a diagnosis or illness.
• Ideas about the problem?
• What do they think would be helpful next step?
• What has already been tried?
• What is hoped for from psychology?
• What other systems/professionals are involved?
• Are the family aware of the referral?

Levels of Psychosocial Need

• Paediatric psychosocial preventative health model (PPPHM)
• Clinical/Treatment (10-15%): Persistent/escalating distress, high-risk factors that require a consultation with a behavioral health specialist.
• Targeted (30-40%): Acute distress, risk factors present that require interventions and monitoring of distress.
• Universal (40-45%): Children and families are distressed but resilient and need general support and psychoeducation.

Levels of Intervention

• Interventions for the young person include problem-solving skills, support to make sense of thoughts and feelings, and psychoeducation (mindfulness, ACT, CBT, narrative therapy).

• Family interventions include narrative ideas (the problem is the problem, not the person) and systemic ideas (family relationships and interactions/family life cycle).

• Interventions for the wider system involve medical team consultation and liaison and communication with the team and family.

• Information given to young people depends on age and developmental stage.

• Conversations about illness are not one-off events.

• Be reflective

• Recognize limits and boundaries.

• Supervision is important because of the difficulty separating personal and professional lives.

Socio-Economic-Cultural Factors

• Societal attitudes around health, development, and expertise.
• Family narratives.
• Cultural and faith-related beliefs.
• Public beliefs and perceptions, including stigma, prejudice, pity, and knowledge and education.
• Economic context, including funding and fundraising.
• Media, including scandals and investigations.

Case Study: Naming of Condition

• 9-year-old boy with cancer whose parents haven’t told him of his diagnosis.
• Parents have noticed changes in behaviour and sleep pattern.
• Questions to ask: How do you feel? What level of intervention might this need?