An overview of the Emotional and educational needs of children with hematological and oncological conditions

1

What are the emotional and educational needs of children with hematological/oncological conditions?

Although every child is different, there are certain considerations when it comes to the emotional well-being of children with chronic and acute medical conditions. A group of psychosocial experts came together to establish standards of care for children with oncological conditions, many which are applicable across pediatric medical conditions. They highlight, among other areas, the importance of psychosocial screening, psychological intervention, neuropsychological assessment, academic support, support for parents and siblings, addressing adherence, and procedural support.

2

How do children with hematological/oncological conditions typically adjust to their diagnoses?

There are various factors that influence how children will adjust to medical conditions, including preexisting vulnerabilities, genetic predisposition, and environmental factors. The Pediatric Psychosocial Preventative Health Model by Anne Kazak proposes that children with acute or chronic medical illness may be categorized into three groups:

• Universal group: The majority of children adjust with limited psychological intervention, may experience some distress but adapt, and benefit from limited screening and information.

• Target group: Children in this group may experience some distress and have characteristics that put them at higher risk; thus they benefit from intervention focused on the symptoms experienced.

• Clinical/Treatment group: Children in this group experience significant levels of distress and benefit from mental health treatment.

3

How can caregivers help their children adjust to new medical diagnoses and treatments?

Families should be encouraged to help children integrate their diagnosis into their daily lives and form a new routine and sense of normalcy. This includes being open with others so as to not be burdened by keeping their diagnosis a “secret,” having set expectations around medications and treatment, and engaging in the typical daily activities of childhood (e.g., school work, chores, remaining connected to peers) to the extent medically possible. Caregivers may have questions as to how much misbehavior to allow. It is important to encourage them to expect their children to behave in a developmentally appropriate way (to the extent medically feasible) to encourage their overall positive adjustment.

4

Identify the reasons for common referrals to a pediatric clinical psychologist or mental health professional

It is expected that when faced with a new diagnosis/treatment/prognosis, a child will exhibit a range of emotional and behavioral reactions. When their reactions do not lessen or begin to interfere with their ability to engage in care and other aspects of daily life, referral to a pediatric clinical psychologist or other mental health professional may be warranted. Adjustment disorders, in which an individual has significant and enduring distress related to an expected stressor, may occur. Some children may develop persistent sadness that leads to diagnoses of depression, or persistent worries that are diagnosed as anxiety. At times, children with medical conditions may experience behavioral difficulties. Changes in setting (e.g., being hospitalized) and routines may lead them to act out. At times, it may be difficult to disentangle side effects of the medical condition/treatment from a psychological symptom such as irritability, pain, disruption in sleep, and loss of appetite. Thus close collaboration between mental health and medical professionals is optimal.