Chapter 13 – Health-Related and Substance-Use Disorders
Health-related disorders are different from other mental disorders largely because children’s
adjustment problems are more directly connected to the impact of the physical illness.
The field of pediatric psychology stresses the interaction between physical and mental health
because the various disorders and developmental problems all share medical, psychological, and
psychosocial components.
History
Psychosomatic are physical disorders caused or affected by psychological and social factors.
Later, this term was replaced by the term psychophysiological, meaning that psychological
factors affected somatic (physical) function.
à These terms are now longer in use, because they wrongly implied that someone’s physical
symptoms were caused solely by mental problems.
How children adapt to the many situational, developmental, and chronic stressors affecting their
health and well-being is a primary interest of pediatric health psychology.
History – Section Summary
- For centuries, poorly understood physical symptoms have been misattributed to psychological
causes.
- Today, pediatric health psychologists study how children’s health-related problems interact with
their psychological well-being and how they and their families adapt in response.
Sleep-wake disorders
Sleep serves as a fundamental role in brain development and regulation. This explains why sleep
disturbances can affect overall physical and mental health and well-being and why sleep
disorders are important to abnormal child psychology.
Sleep disorders are important to abnormal child psychology because they mimic or worsen
many symptoms of the major disorders.
Sleep-wake disorders are likely are result of abnormalities in the body’s ability to regulate sleep-
wake mechanisms and the timing of sleep. Whereas sleep problems are related to a medical or
mental disorder or the use of medications.
2 categories of sleep-wake disorders (most relevant to children and youths):
1. Dyssomnias: a category of sleep disorders involving difficulties initiating or maintaining
sleep. Such disorders are often characterized by problems with getting enough sleep, not
sleeping when one wants to, and not feeling refreshed after sleeping.
2. Parasomnias: a category of sleep disorders in which behavioral or physiological events
intrude on ongoing sleep. Persons suffering from parasomnias often report unusual
behaviors during sleep, such as sleepwalking and nightmares.
Dyssomnias
Dyssomnias are common childhood affliction.
• Insomnia disorder: difficulty initiating or maintain sleep, or sleep that is not restorative
• Hypersomnolence disorder: excessive sleepiness.
• Narcolepsy: irresistible attacks of refreshing sleep occurring daily, accompanied by brief
episodes of loss of muscle tone (cataplexy). This disorder poses an increased risk of
cognitive and emotional problems including depression, anxiety and low self-esteem.
• Breathing-related sleep disorder: sleep disruption caused by sleep-related breathing
difficulties. This leads to excessive sleepiness/insomnia.
, • Circadian rhythm sleep disorder: persistent sleep disruption leading to sleepiness due to
a mismatch between the sleep-wake schedule required by a person’s environment and
his/her internal sleep cycle.
Parasomnias
Parasomnias include:
• Nightmares: a form that occurs during rapid-eye-movement (REM) sleep and is
characterized by repeated awakening with detailed recall of extended and extremely
frightening dreams, usually involving threats to survival, security, or self-esteem.
• Sleep terrors: a form that occurs during sleep (non-REM/NREM) and is characterized by
abrupt wakening, accompanied by autonomic arousal but no recall.
• Sleepwalking: a form that occurs during deep sleep (non-REM/NREM), in which the
individual gets out of bed and walks around but has no recall of such activity upon
awakening.
The DSM-5 diagnostic criteria for all sleep-related disorders emphasize:
1. The presence of clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
2. The requirement that the sleep disturbance cannot be better accounted for by another
mental disorder, the direct physiological effects of a substance, or a general medical
condition.
Treatment
Behavioral interventions:
• Teach parents to attend to the child’s need for comfort and reassurance, but to gradually
withdraw more quickly from the child’s room after saying goodnight.
• Teach parents to establish good sleep hygiene appropriate to their child’s developmental
stage and the family’s cultural values. Once established, positive reinforcement methods
can be used to reward the child.
Treatment of circadian rhythm sleep disorders requires a highly motivated adolescent and a
supportive family.
à Goal of behavioral intervention:
1. To eliminate the sleep deprivation
2. To restore a more normal sleep-wake routine
In addition: melatonin supplements have shown some effectiveness with children and
adolescents.
Sleep-Wake Disorders – Section Summary
- Sleep disorders are important to abnormal child psychology because they mimic or worsen many
symptoms of the major disorders.
- Sleep disorders can cause psychological problems, result from other disorders, or be a symptom
of trauma or stress in the child’s life.
- Dyssomnias are disorders of initiating or maintaining sleep, and include hypersomnia,
narcolepsy, breathing-related sleep disorders, and circadian rhythm disorder.
- Parasomnias are sleep disorders in which behavioral or physiological events intrude on ongoing
sleep, arousing the sleeper. They include nightmares, sleep terrors, and sleepwalking.
- Although most dyssomnias and parasomnias of childhood are common and often disappear with
maturity, they still may have a negative impact on the child’s daily activity and adjustment.
Effective psychological treatments for most child sleep disorders involve the establishment and
regulation of bedtime routines.
