Ale, Chelsea M.

Objective: This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up. Methods: Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up. Results: Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up. Discussion: This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.

Significant functional impairment and psychological distress have been observed in adolescent patients with postural orthostatic tachycardia syndrome (POTS). Interdisciplinary rehabilitation programs have been shown to be beneficial in the treatment of chronic pain in adults and adolescents. Only preliminary data have examined interdisciplinary rehabilitation efforts in patients with POTS. This study evaluated the impact of an interdisciplinary rehabilitation program on the functional impairment and psychological distress in 33 adolescents diagnosed with POTS. Patients included in the study were adolescents ages 11 to 18 diagnosed with POTS. Measures completed at admission and discharge from the program included the Functional Disability Index, Center for Epidemiological Studies–Depression–Child scale, and the Pain Catastrophizing Scale for Children. After participation in the 3-week program, adolescents with POTS demonstrated a significant increase in overall functional ability and significant reductions in depression and catastrophizing.

These case examples depict the use of a smartphone application, Mayo Clinic Anxiety Coach, to enhance the treatment of pediatric obsessive-compulsive disorder (OCD). The presented cases highlight the use of Anxiety Coach as a stand-alone intervention for mild OCD symptoms and as an adjunct to treatment for severe OCD complicated by geographical barriers. Each case includes a description of treatment, patient use of the application, objective assessment of clinical symptoms, and a qualitative interview with the families. Both patients responded well to treatment and had a positive experience with Anxiety Coach. The application encouraged the families to complete exposures between sessions and allowed a detailed examination of the patients’ engagement in homework assignments. Potential uses of smartphone applications to address challenges facing treatment of, and research on, OCD are discussed.

Although compulsive hoarding may pose health, social, and developmental impairment for children, there are few phenomenological and treatment studies to guide assessment and treatment. Current evidence-based questions the link between hoarding and obsessive compulsive disorder (OCD) and the effectiveness of cognitive behavioral therapy protocols for OCD to adequately address the unique challenges of poor insight, poor emotion regulation, and increased family accommodation in children with compulsive hoarding. This case study seeks to illustrate a family-based behavioral approach to outpatient treatment of compulsive hoarding with a 9-year-old girl (pseudonym Lily). Treatment included psychoeducation, exposure to discarding items, exposure to acquiring cues, and parent behavior management techniques.

Selective Mutism (SM) is a highly impairing disorder which typically presents upon entry to school and affects approximately 0.7% of children. Despite its impact on social and academic development, it is a difficult disorder to treat and there is a small evidence base for behavioral treatment. Preliminary evidence suggests that behavioral treatment focused on exposure to social interactions, social skill building, and involvement of caregivers in treatment may be promising. This article presents two cases of early childhood SM to demonstrate the importance of tailored treatment implementation to meet the individual needs of each family and help children resume typical social development.