понедельник, 17 сентября 2012 г.

Effective & Emerging Treatments in Pediatric Psychology.(Book review) - Families, Systems & Health

Effective & Emerging Treatments in Pediatric Psychology

By Anthony Spirito and Anne E. Kazak Oxford University Press, New York, 2006, 180 pp.

DOI: 10.1037/1091-7527.24.4.471

Attention all health care providers interested in helping their pediatric patients with common difficulties such as pain, enuresis, sleep problems, and treatment adherence. Drs. Spirito and Kazak, well known clinicians and researchers in the field of pediatric psychology, demonstrate a talent for informing readers of the latest research and treatment protocols for helping children with pediatric health conditions in their newest book, Effective & Emergent Treatments in Pediatric Psychology. Their ability to deliver information concisely and practically is refreshing for those familiar with the field as well as those just being introduced. And all under 200 pages!

The book lays the groundwork for the main body of specific intervention with a helpful overview of evidence-based pediatric psychology interventions, the inherent challenges that arise in research, and the pros and cons of manualized treatment protocols. The discussions are thoughtful yet succinct, a trait consistent throughout the entire book.

The world of pediatric psychology is dominated by behavioral and cognitive-behavioral interventions. This is not surprising news, as the authors note, for, 'many of the problems encountered by pediatric psychologists naturally lend themselves to contingency management approaches (e.g., sleep onset difficulties, self-control and pain management).' Spirito and Kazak provide an excellent overview of relaxation techniques, problem solving methods and anger control strategies. Each discussion is enhanced with sample procedures, especially the relaxation techniques. The authors conclude this chapter, as well as subsequent chapters, with their 'helpful hints.' These hints have proven quite useful in my own work with children and adolescents, and I found myself eagerly looking forward to them at the end of chapters.

Many health care providers know the importance of considering the impact of family, school and hospital contexts when working with pediatric populations. Spirito and Kazak effectively review ecological and biopsychosocial as well as other systems theories prior to their discussion of evidence-based family interventions. Synopses are punctuated by concise descriptions of research studies in the areas of adherence, stress reduction, and school interventions, to name a few. I thoroughly enjoyed the clear example of a manualized family intervention to reduce posttraumatic stress syndrome symptoms for adolescent survivors of childhood cancer and their families (which was developed by Kazak and colleagues).

Pain management is an important area in which many pediatric psychologists provide consultation, assessment, and treatment. Spirito and Kazak review four areas of pediatric pain, including recurrent pediatric headache, recurrent abdominal pain, procedure-related pain, and disease-related pain. Their discussions of each area begin with a concise review of the literature to date, followed by clear examples of clinical applications of the research, which tend to be variations of behavioral interventions. I found the practical review of recurrent pediatric headaches helpful and was able to enrich my own protocol with their suggestions.

Treatment adherence is another aspect of pediatric chronic illnesses that can be a source of serious consequences for the patient and concern for the health care professional. Spirito and Kazak skillfully cover a wide array of techniques to use with adolescents and families, including helpful handouts for exasperated parents. As I read these discussions, I found myself actively storing these recommendations in my 'treatment vault' to help families address adherence issues.

The next section of the book reviews common disorders seen in pediatric (and, in my experience, primary care), psychology including nocturnal enuresis, encopresis, and sleep problems in children. Spirito and Kazak thoroughly yet concisely review the literature of each disorder and provide easy to follow intervention strategies. For instance, the authors provide practical guidelines for parents reviewing the medical management of encopresis that parents will find manageable and helpful. I personally liked how Spirito and Kazak provide several different options for the treatment of each disorder, yet also discuss the practical limitations of each option. An example of this occurs with the discussion of biofeedback for encopresis. Although the authors report that this method is 'probably efficacious,' they also note that more recent studies 'have questioned whether biofeedback is really of added value.' Similar discussions are provided for nocturnal enuresis and sleep problems. I also appreciated how each review of the three disorders concluded with a 'clinical issues' and 'research issues' discussion. The authors provide brief, valuable pearls in each of the discussions that will be welcomed by clinicians and researchers. I will add several of these pearls to my discussions with parents about the use of urine alarms for nocturnal enuresis, including for example 'ensuring that children wear thin underpants or pajamas so the urine contacts the alarm on the bed sheet as quickly as possible.'

The book concludes with an interesting overview of enhancing treatment adherence for cystic fibrosis. Several promising interventions for chest physiotherapy, exercise, and diet are reviewed in detail. An additional bonus is the inclusion of a treatment manual developed Drs. Stark and Quittner, leading pediatric psychology researchers in the area of cystic fibrosis, that is available on the book's companion website.

Overall, Effective & Emergent Treatments in Pediatric Psychology is an excellent resource for those health care professionals interested in treating pediatric health conditions. The authors provide readers with concise and practical manualized treatments that are empirically tested and can be used by mental health and medical professionals, especially when working with issues related to pain, adherence, elimination disorders, and sleep. As noted above, the authors generously include a companion website for the book, which adds to the many resources they provide for their readers. I plan on using many components of this book to enhance my work with children, adolescents, and families in family medicine. I hope my colleagues in the fields of primary care and mental health will seriously consider adding this book to their library.

Alex J. Reed, PsyD

Department of Obstetrics and Gynecology

University of Kansas School of Medicine--Wichita