Therapeutic intervention with terminally ill children: A review.

Abstract

This article reviews the literature ojpsychological treatment strategies used with terminally ill children. Important variables for effective treatment are discussed to provide a framework for psychological intervention in a pediatric setting. (Much of the material in this area is of an anecdotal or case-presentation type.) It is hoped that this review will encourage further research to test current intervention theories and will point out variables that should be considered in any intervention program.As medical treatments have extended the life expectancy of a terminally ill child an average of 5 years, mental health professionals have become increasingly aware of the psychological impact terminal illness has on the child and his or her family. This article reviews psychosocial treatment interventions designed to ease the impact of terminal illness, professional role requirements, characteristic patient and familial responses to the illness, common stressors, and coping skills. Professional Role: Responsibility and RequirementsThe clinician working with terminally ill children must assume the roles of educator, patient advocate, supportive confidant, consultant, therapist, and environmental change agent (Berger, 1978;Koocher & Sallen, 1978). He or she must assume the responsibility of dealing with the patient, family members, and medical staff (Easson, 1974).The clinician must have knowledge of pediatrics and childhood malignancies as well as child development and psychopathology. Becoming familiar with the nature of each terminal illness, the prognostic and process variables, and the medical treatments, side effects, and complications is essential to effective treatment. To this end, the clinician may refer to Koocher and Sallen (1978) and the oncology volume of The Pediatric Clinics of North America journal (1976). He or she must also address his or her own personal feelings about death and the dying process (Lewis, 1978). Impact of IllnessChildren's responses to terminal illness vary with age, length of illness, frequency of relapse, premorbid adjustment, and the responses of others (Lewis & Armstrong, 1978). Anxiety, fear, withdrawal, anger, and depression are displayed (Drotar, 1975; Drotor & Ganofsky, 1977). According to Spinetta (1974), the primary source of anxiety differs depending on the developmental age, for example, separation anxiety (ages 1-5), mutilation anxiety (ages 5-10), and death anxiety (ages 10 and above). Adolescents are particularly vulnerable, considering the greater likelihood of their awareness of malignancy . Fear of losing control (Drotar, 1975), increased dependency and perceived helplessness (Heffron, Bommelaere, & Masters,