© Borgis - Postępy Nauk Medycznych 1/2013, s. 100-102
The current issue of “Postępy Nauk Medycznych” (“Progress in Medicine”; PNM) is devoted to problems related to developmental disabilities and evidence-based approaches to their treatment. Gathered papers have been written by representatives of separate disciplines – medicine and psychology – and are presented by us in order to convey interdisciplinary knowledge to family doctors and doctors practicing within primary health care. Reporting medical and psychological information was our goal, because in case of developmental disabilities, recommended treatment should be comprehensive, and thus provided by a variety of professionals. It is very important that there is a transfer of knowledge among those professional as it will likely result in faster and more appropriate recommendations that are given to parents by family doctors and primary health care providers. This issue on PNM is divided into three parts: review papers, original papers and clinical corner.
In the introductory article, prof. Irena Namysłowska writes that in Poland about 10% of children and adolescents suffer from psychiatric disorders. Taking into consideration that in our country there is around 7,5 million individuals from this age group, 750 000 young people need help. We cannot forget about their families, who often also need support. Thus, mental health of children and adolescents is an important social issue exacerbated by the fact that the majority of patients do not have access to help. What are the aims of mental health care system for children and adolescents? Prof. Namysłowska writes that they are as follows: 1) supporting families, teachers, social services, pediatricians, general practitioners and the care system of mother and newborn child, as well as other social agendas in the process of rising the children, 2) developing systems of early interventions, 3) delivering effective health care, and 4) providing services that are accessible to all children in order to minimize their suffering, reduce disability and help to promote their developmental potential. The most needed are community services such as outpatient clinics, day departments, crisis interventions centers. Unfortunately, there are several obstacles to optimal functioning of health care system in Poland. One of the solutions can be offering prophylactic programs as well as effective and generally available therapy.
We present to the readers of PNM six review papers. The first one is written by an American psychologist – prof. Joseph Wyatt. This paper is devoted to a phenomenon that is common in the United States, namely overreliance on the biological model in trying to explain causes of many psychological disorders. Wyatt calls this phenomenon “medicalization”. The roots of contemporary medicalization in the U.S. are traced to two primary factors – psychiatry’s efforts to re-gain lost status, and the pharmaceutical industry’s profit motives. Given that both psychiatry and the drug industry are global enterprises, medicalization threatens to escape the boundaries of the U.S. and spread to other nations. We realize that some of the theses set by prof. Wyatt are controversial, but we have decided to present his paper in order to point the attention of the readers to potential negative results of medicalization and offer some recommendations regarding therapeutic interventions.
Malicki, Dudek-Głąbicka and Ostaszewski also write about the medical model. The article focuses on the role of general practitioners and pediatricians in prevention and treatment of children’s mental health problems. The authors emphasize the role of communication between clinicians and parents of child patients, because practitioners’ attitude to and understanding of the nature of treated problems is thought to have a significant impact on children, their parents and other caregivers, and can be crucial for treatment outcomes. Malicki et al. describe a functional-contextualistic approach to mental health which can be seen as an alternative to the medical model. Functional-contextualistic approach situates psychological problems within the context of personal history and current life circumstances of an individual. Presented symptoms are seen as behaviors which have developed in the course of life as an apparently unsuccessful way of coping with life problems. The paper presents fundamentals of functional-contextualism and contains a discussion of their implications for understanding of health problems. The article concludes with advice regarding practical applications of functional-contextualistic philosophy of health to the relationship between clinicians and parents.
The next four articles describe the foundations of behavioral approach and the effectiveness of behavioral therapy for several childhood problems. Presti, Cau and Moderato write from the perspective of behavior analysis about changing eating habits of children. The authors report that a number of feeding and eating problems may arise early in a child’s life and are defined by his/her inability or refusal to eat or drink a sufficient quantity or variety of food to maintain proper nutrition. Problematic feeding is ascribed to many causes, and it mainly arises from the interaction of biological and environmental factors. In this paper the authors discuss a wide range of strategies elaborated within a behavior analytic framework to show how feeding and eating in children can be effectively modified. They focus on how behavior analysts conceptualize problematic feeding, examine some examples of intervention strategies for different feeding problems, and sketch how a behavioral based intervention on a large scale may increase fruit and vegetables consumption in children between 2 and 11 years old and ultimately help in preventing child’s obesity. This article is an important source of information, especially in the light of a fact that 20-40% of children present some problems related to feeding, with the number reaching 80% in case of developmental disabilities.
Bąbel, Trusz i Ziółkowska discuss behavioral techniques of pain management used in clinical practice in children and adolescents and review the results of the studies aimed at assessing their effectiveness. The results of the studies both on the epidemiology of pain in children and adolescents and the effects of pain on children and adolescents’ functioning are summarized. Three types of behavioral therapies of pain are discussed: operant, respondent and cognitive-behavioral. Case studies and meta-analyses of the randomized controlled trials of the effectiveness of behavioral techniques of pain management in children and adolescents are reviewed. The authors conclude that the results quite clearly support the use of the behavioral techniques in pain management in children and adolescents.
Suchowierska and Novak focus on a very important issue of science and pseudoscience in the treatment of autism. Terms such as “evidence-based practice” or “best practices” reflect a crucial aspect of clinical work, as they point to science as means for evaluating treatment effectiveness. Unfortunately, in the area of developmental disabilities dubious and pseudoscientific interventions are all too prevailing. Suchowierska and Novak describe premises of the scientific method and contrast it with pseudoscience. They also list the reasons for popularity of unsubstantiated claims in autism treatment. One of the main contributions of this article is a summary of a recent report on practice guidelines prepared by the National Autism Center. We believe that information from the current article will be a very good source of facts regarding therapeutic interventions for parents of children with autism as well as practitioners who may come in contact with those parents.
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