Psychological Interventions in Childhood Chronic Illness


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‘Outstanding’ work focuses on pediatric health psychology
(July 2007 Issue)

“Psychological Interventions in Childhood Chronic Illness”
By Dennis Drotar
American Psychological Association
Washington, D.C., 2006

By James K. Luiselli Ed.D.

Chronic illnesses such as asthma, diabetes and cancer impact many children and their families. The devastating effects from persistent medical disorders demand comprehensive and multidisciplinary treatment. This book addresses psychological intervention as one component of health care.

Author Dennis Drotar is a pediatric psychologist specializing in childhood chronic illness. Early chapters in the book outline some of the areas that can benefit from psychological intervention, for example, promoting illness management, improving adherence to medical regimens and teaching coping skills. Throughout the book, the author examines these and related therapeutic objectives with an eye toward empirically supported and evidence based procedures.

There are several informative chapters that provide an overview of salient issues in the care and treatment of children who have a chronic illness. The targets of intervention include child, family, school and peers. Drotar argues cogently that intervention procedures must be adjusted to the type of illness and treatment context. To illustrate, a child-centered intervention might embrace cognitive-behavioral training whereas a school-centered intervention would be more "systems" oriented.

The book also introduces the reader to different theoretical models and frameworks for intervention research. Children with chronic illness are susceptible to many risk factors, often operating synergistically, with serious impact on long-term health status. The principles governing distinct theories receive meaningful coverage and importantly, how they relate to clinical practice.

With an emphasis on empirically supported treatment, Drotar devotes several chapters to pertinent research considerations. His discussion of experimental design, measurement, hypothesis testing and statistical analysis is outstanding. On a practical level, he offers many suggestions for implementing collaborative research projects in pediatric health-care settings, securing resources and confronting potential ethical challenges.

In a sequence of individual chapters, the author details psychological interventions with representative chronic illnesses, specifically childhood asthma, diabetes, cancer, sickle cell disease, rheumatoid arthritis and cystic fibrosis. Each chapter has a similar format, starting with a description of the illness, followed by a review of medical treatment, psychosocial effects and psychological intervention studies. The chapters conclude with an impressive list of recommendations for clinical care and future research.

This book is one of the best I've read in the area of pediatric health psychology. Evidence of the author's clinical and research expertise is abundant within its pages. Notably, the book imparts much useful information about childhood chronic illness by synthesizing current knowledge with scholarly critical scrutiny. The inclusion of illness-specific chapters also should be highlighted because readers can focus their attention on topics of specific interest or learn more about less familiar ones.

Drotar introduces his book by stating that he seeks to describe "the state of the art in psychological intervention research, detailing relevant methodological and clinical challenges in conducting such research and proposing recommendations to improve the science and practice of psychological interventions." Few books achieve all of their stated goals but this one does with clarity, precision, and accordingly, high praise.

James K. Luiselli, Ed.D, ABPP, BCBA, is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.