Annotated Abstracts

Improvement in health care for individuals with cystic fibrosis (CF) has resulted in increasing the length of survival from a median of 12 years of age in 1966 to greater than 30 years of age in 2004. Health professionals need to be more proactive in helping children with CF learn how to manage their chronic illness within the context of the psychosocial and developmental needs of childhood and adolescence. In earlier research with children with CF, the authors identified the period of middle childhood, when children enter school and begin their peer interactions, as an important time to assist children with CF in learning how to balance the desire to be normal in the eyes of their peers and the unique needs of their chronic illness.

The purpose of this experimental, repeated-measures study was to test the effectiveness of a life skills intervention to improve the psychosocial adjustment, functional health status and physiological status of children 8-12 years of age with CF by teaching them to manage their chronic illness in their everyday lives. Children with mild CF were randomly assigned to either receive usual care (n = 58) or the intervention (n = 58). Children in the intervention group participated in a home visit to assess their knowledge and management of CF and to receive information tailored to the child’s individual needs. Then each child participated in a small-group intervention (n = 4 children with CF) with problem-solving discussions that focused on social skills training for explaining CF to peers, dealing with teasing, and keeping up with classmates in physical activity. Children in both groups completed a number of standardized instruments evaluating psychosocial adjustment and functional and physiological health status at baseline and three time periods following the intervention, 3, 6, and 9 months.

While the children in the two groups did not differ significantly on a number of the measures, the children who received the intervention group did show decreased perceived impact of illness on quality of life (P < .0001) and decreased loneliness (P < .0001) following the intervention. These differences were maintained (P < .01) in both of these areas at the 9-month follow up. Both of these areas are important to the adjustment of these children and the social consequences of having a chronic illness in the midst of children who, in general, are not facing a similar illness.

The authors of this article are to be commended for their sustained research in the psychosocial needs of children with CF. The intervention tested in this article was developed based on their earlier research with children with CF that included specifically asking these children what their needs were. Their intervention may also be valuable for children with other chronic conditions who also need problem-solving social skills to address the social concerns they encounter in school with peers. As primary care providers, it is important to recognize not just the physical needs of the chronically ill children we care for, but also their psychosocial needs. Children with CF present unique challenges for their health care providers. While their increased survival means that the more acute phases of their illness may be deferred to adulthood, it is up to their pediatric providers to assist them in developing positive psychosocial coping skills early. Hopefully these skills will continue to help them into adolescence and adulthood.

Recurrent pain, such as headaches, abdominal pain, and back pain, are common problems that frequently bring children and adolescents to pediatric practices and school health offices. In a large community sample, 25% of children reported ongoing or recurrent pain during a three month time period. These children are often a treatment challenge for their health care providers. Research indicates that the most effective interventions for these problems appear to be cognitive-behavioral interventions that include relaxation strategies. Unfortunately, not all children have ready access to providers that are able to provide the ongoing cognitive-behavioral interventions needed to address these problems. Although on-line treatment approaches have been minimally tested for this type of recurrent problem, they may appeal to children and adolescents and may be an effective approach to providing proven cognitive-behavioral interventions.

The purpose of this study was to evaluate the clinical efficacy of an Internet-based treatment program for pediatric recurrent pain as compared to a standard medical care control group. Children, 9 to 17 years old, who experienced at least three episodes of abdominal or head pain in a three month time period, participated in this study. These children were stratified by age and pain intensity and randomly assigned to either the treatment (n = 25) or standard care (n = 22). Children in the treatment group had access to a web site that contained seven chapters of a Pain Module with information focused on relaxation techniques and cognitive strategies. (The module is located at: www.usask.ca/childpain/research/hicks/). Children in both groups completed an intake interview, a daily pain diary, a quality of life measure, and visual analogue scales assessing treatment expectations and treatment evaluation.

The internet based intervention group had more children report a clinically significant decrease in pain three months following the intervention (72% of the children) compared to the control group (only 14% of this group at 3 months follow up). No differences in quality of life were found between the two groups.

Children and adolescents are particularly receptive to using the internet, making an internet educational intervention a potentially valuable approach for this age group. The internet intervention described in this article provided a cost effective intervention for children with recurrent pain, eliminating potential barriers to treatment such as access and cost. Future research is needed to further test use of the internet in interventions for children and adolescents.