Stage
Age (in years)
Description
Sensorimotor
0–2½
Infants and toddlers acquire knowledge through sensory experiences and manipulating objects
Preoperational
2½–6
Youth learn through pretend play, but still struggle with logic and taking the point of view of others
Concrete operational
6–12
Youth begin to think more logically, but their thinking can also be very rigid. They tend to struggle with hypothetical and abstract concepts
Formal operational
12+
Youth develop the ability to use deductive reasoning and an understanding of abstract thinking
Transition to Adult Care Starts Early
Transitioning from one developmental stage to the next may require time-sensitive support (i.e., early childhood to Kindergarten, middle school to high school, then to college/vocational training, then to work).
Starting at age 14, the team should begin the transition process to adult care.
Vocational rehabilitation services can be a valuable resource as the child approaches young adulthood.
The child should assume increasing responsibility for his or her own care as he or she ages.
Importance
The field of pediatric psychology rehabilitation applies to a variety of childhood conditions. There are congenital and chronic conditions such as cerebral palsy , spina bifida, and developmental delay which often require various rehabilitation services across the entire life span. Then, there are acquired traumatic conditions which require an acute inpatient rehabilitation stay followed by outpatient chronic management, such as burns, limb deficiency, traumatic brain injuries, and spinal cord injuries. Some of these pediatric conditions are reviewed below:
Cerebral Palsy (CP) [3]
In the developed world, CP occurs most often in youth who were born prematurely and affects approximately 2 in 1000 children. CP can also be caused by infection in the womb, prenatal insults, or genetic conditions.
CP describes a group of chronic disorders with limitations in mobility and hand use and with commonly associated impairments in sensation, cognition, communication, and behavior. These children can have involvement in only one side of their bodies (hemiplegia) or bilaterally (quadriplegia). The most common form of CP involves an abnormal increase in muscle tone called spastic CP, but other forms can involve jerky or slow and writhing movements (dyskinetic CP), and uncoordinated movements (ataxic CP).
Approximately 50 % of children with CP have intellectual deficiency and many those with more typical cognitive skills demonstrate some level of learning disability. Academic support and social skills development often provide some benefit. Vision, hearing, and speech and language impairments are also rather common in this population resulting in the need for ongoing multidisciplinary therapies to address all of the child’s needs and to enhance quality of life.
Spina Bifida (SB) [3]
SB is the most common form of neural tube defects which results from malformations of the brain, spinal cord, and vertebrae in utero.
In the United States, approximately 3 per 10,000 infants were born with some form of SB (not including terminated pregnancies).
The causes of SB remain complex and unclear. It is known that both environmental and genetic factors can play a part. Specifically certain genetic mutations, maternal exposure to certain medications (certain antiepileptic and acne medications), maternal alcohol abuse, maternal exposure to hyperthermia, and maternal diabetes and obesity have been shown to result in increased occurrence of SB.
The malformation leading to SB affects the entire central nervous system. The primary neurological abnormalities are paralysis and/or loss of sensation below the level of the spinal cord defect, bowel and bladder issues, learning disabilities, and Chiari type II malformation with associated hydrocephalus.
Psychosocial issues such as body image issues, depression, social difficulties, self-esteem issues, lack of motivation, decreased participation, difficulties dealing with sexual changes and feelings. It is important to note that one’s level of distress is not necessarily related to his or her level of function.
Burns [4]
Approximately 1.5–2.0 million people sustain burn injuries every year resulting in about 70,000–100,000 hospitalizations of which 50 % of them are children and adolescents.
Burns are the fifth leading cause of accidental death in children with 5500 deaths per year. Children under 5 years old account for over half of all pediatric burns.
Etiology varies according to developmental level. Toddlers are susceptible to liquid and food spills; preschoolers and school-age children tend to sustain injuries during experimental play with lighters, matches, and kitchen devices; and adolescents tend to get hurt outside the home.
Burns range from first degree to the more serious third degree in nature and can affect varying amounts of body surface area.
Common psychological consultation issues in this population in the acute phase have to do with mental status, behavioral support for nutritional intake, body image issues, behavioral interventions for intense itching sensations, post-traumatic stress disorder/anxiety/depression concerns, disruptive behaviors, adherence to treatment demands, family issues, and pain management.
These psychological concerns can continue into the rehabilitative stage of treatment and can benefit from continued support and intervention from all members of the treatment team.
Traumatic Brain Injury (TBI) [3]
Each year, approximately 119 per 100,000 children under 18 years of age sustain a TBI.
The most popular etiology in young children (ages 0–4) is falls (65 %), while the largest contributor in the oldest children (ages 15–17) is motor vehicle accidents (26 %).
TBI ranges from mild to severe and require differing levels of rehabilitation. Mild injuries, including concussions, often require only rest and time and most children are expected to have a full recovery. Whereas moderate and severe injuries come with motor, sensory, communication, and cognitive impairments and feeding disorders which often require ongoing multidisciplinary therapy interventions.
Following TBI, the child can also demonstrate behavioral and emotional changes including adjustment difficulties, psychiatric disorders (including anxiety and/or depression), disinhibition, impulsivity, poor safety awareness, social withdrawal, and inappropriate social behavior.
Approximately 3–5 % of all cases of traumatic SCI (or about 600 of the just over 12,000 new cases per year) occur in children younger than 15 years of age and in 20 % of all cases (or about 2400) when including all those up to 20 years of age.
Motor vehicle accidents are the most common etiology of SCI in children, with falls, violence, and sports being the next most common causes. Unique etiologies of SCI in children include lap-belt injuries, birth injuries, child abuse, SCIs without radiologic abnormalities (SCIWORA) , upper cervical injuries, and transverse myelitis.
SCI is described by the level of the injury as measured by the International Standards for Neurological Classification of SCI (ISNCSCI) . Studies of this measure in pediatric populations have found the reliability of the motor and sensory examinations to be good in children aged 5 years and older. It is important to note that the anorectal examination has questionable reliability when conducted on a child who had never been toilet trained before his or her injury.
Common reasons for psychological consultation during acute rehabilitation of a child or adolescent with SCI are depression, anxiety, lack of appetite, trouble sleeping, irritable/aggressive behavior, social withdrawal, noncompliance in therapy or with medical treatment, engagement in self-destructive behavior, and suicidality. Any or all of these issues can continue after rehabilitation as adjustment to the injury occurs over years.
Youth with SCI seem to experience lower levels of participation and quality of life when compared with normative data [6, 7].Related posts:
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