Chapter Thirteen

Health-Related and Substance-Use Disorders

Introduction

  • Quotation by Mahatma Gandhi: "It is health that is real wealth and not pieces of gold and silver."

Chapter Overview

  • This chapter explores various health-related problems in children and adolescents, including:

    • Sleep and wake disorders.

    • Elimination disorders.

    • Chronic illnesses.

    • Adolescent substance-use disorders.

History of Psychological Approaches

  • Psychological approaches towards aiding children with health-related problems have evolved over the last two decades, with roots stemming back through Greek philosophical understandings of health.

  • Historical misconceptions have often attributed physical symptoms to psychological causes.

Sleep-Wake Disorders

Importance of Sleep

  • Sleep is fundamentally vital for brain development, especially during the early years of life:

    • By age 2, children have spent about 10,000 hours asleep and 7,500 hours awake.

    • Neuroscientific evidence shows sleep facilitates maturation in cognitive skills and socio-emotional development.

Common Sleep Problems in Children

  1. Freddie, Age 12: Suffers from sleep onset insomnia, taking 1-2 hours to fall asleep due to anxiety.

  2. Jeremiah, Age 4: Experiences asthma, leading to panic and requiring frequent medical assistance for breathing difficulties.

Effects of Sleep Problems

  • Sleep-wake disorders can significantly worsen symptoms tied with ADHD, depression, and anxiety disorders.

  • Sleep problems can arise due to stressors and environmental challenges.

Regulatory Functions of Sleep

  • Sleep serves crucial regulatory functions affecting:

    • Attention, arousal, emotions, and behavior.

    • A dynamic regulatory system within the central nervous system.

Maturational Changes in Sleep Patterns

  • Changes in sleep patterns occur significantly during early development:

    • Newborns sleep 16-17 hours/day.

    • 1-year-olds sleep 13 hours/day.

    • Sleep problems evolve from infancy through to adolescence, showing varying characteristics (e.g., night-waking vs. insomnia).

Features of Sleep-Wake Disorders

  • Sleep-wake disorders are categorized into two types:

    1. Dyssomnias: Involve issues with sleep initiation or maintenance, e.g., insomnia.

    2. Parasomnias: Involve abnormal behavior during sleep, e.g., sleepwalking, nightmares.

Common Types of Dyssomnias

  • Insomnia Disorder: Difficulty in falling or staying asleep.

  • Hypersomnolence Disorder: Excessive sleepiness.

  • Breathing-Related Sleep Disorders: Issues related to sleep apnea.

  • Circadian Rhythm Sleep Disorder: Disorders linked to the timing of sleep.

Common Types of Parasomnias

  • Nightmare Disorder: Frightening dreams causing awakenings and recall of the dream.

  • Sleep Terrors: Abrupt awakenings with autonomic arousal and no memory.

  • Sleepwalking: Engaging in complex behaviors while asleep without memory.

Treatment of Sleep Disorders

  • Generally involves behavioral interventions, establishing sleep hygiene, and family guidance.

  • Melatonin supplements are also noted as effective in restoring sleep patterns.

Elimination Disorders

Overview of Elimination Disorders

  • Two major types of elimination disorders discussed:

    1. Enuresis (bed-wetting):

    • Commonly experienced; often involuntary.

    • Prevalence decreases with age, affecting 1–2% of children by late adolescence.

    1. Encopresis (fecal incontinence):

    • Similar involuntary nature; characterized by inappropriate fecal discharge.

    • Often associated with constipation.

Diagnostic Criteria for Enuresis (DSM-5)

  • Repeated discharges of urine, significant distress, age over 5 years, not attributable to other medical conditions.

  • Incidence ranges from 4% to 13% for those under 10 years old.

Causes and Treatment

  • Enuresis commonly linked to biological, developmental, and psychological factors.

  • Treatment methods include:

    • Bell-and-pad alarm systems for nocturnal enuresis.

    • Behavioral and educational approaches.

    • Laxatives and positive reinforcement methods for encopresis.

Chronic Illness

Definition of Chronic Illness

  • A chronic illness is defined as one lasting longer than 3 months or requiring hospitalization for over one month.

  • Common chronic illnesses in children include diabetes mellitus and childhood cancers.

Impact of Chronic Illness on Development

  • Chronic health conditions significantly affect physical growth and development, social interactions, and are a source of psychological distress.

Diabetes Mellitus

  • Diabetes is identified as a prevalent chronic illness among children:

    • Causes significant lifestyle changes and daily management requirements.

    • Nearly 10% of the youth population affected.

Childhood Cancer

  • Children diagnosed with cancer face unique challenges, including high stress due to treatment and school absences.

  • Long-term treatment implications often result in psychosocial complications.

Biopsychosocial Model of Adjustment

  • Emphasizes interaction between biological factors, psychological factors, and social contexts of illness.

  • Family dynamics play a crucial role in the adjustment and coping strategies of the child.

Effective Coping Strategies

  • Parent involvement and mutual support systems are vital for effective coping.

  • Support groups and educational programs can benefit adjustment processes for children with chronic illnesses.

Adolescent Substance-Use Disorders

Overview of Substance Use Among Adolescents

  • Substance use among adolescents often includes experimenting with substances like alcohol and marijuana, with alcohol remaining the most frequently abused.

  • Key elements include:

    • Cannabis and alcohol misuse rates increasing,

    • Correlation with psychological disorders such as ADHD and conduct disorders.

Diagnosis and Treatment

  • Substance-Use Disorder (SUD) characterized by significant impairment in daily life due to substance use.

  • Treatment methods encompass family systems therapy, motivational interviewing, and educational programs targeting youth involvement and peer influence.

Preventive Measures

  • Emphasis on the importance of prevention efforts during early adolescence focuses on education systems and family involvement to bring awareness of substance abuse issues.

Section Summary

  • The chapter emphasizes the substantial impact of health-related disorders, the role of psychological well-being, family dynamics, and available interventions leading to better adaptations for children and adolescents facing such challenges.

  • Key Terms: chronic illness, dyssomnias, enuresis, encopresis, insulin-dependent diabetes mellitus, morbidity, nightmares, parasomnias, psychological factors affecting other medical conditions, sleep terrors, sleepwalking, somatic symptom and related disorders, substance abuse, substance dependence, substance-related and addictive disorders, substance-use disorders (SUDs).