Cognitive-Behavioral Therapy for Parents and Families of Youth with Chronic Medical Conditions

Editors: Emily F. Law, Ph.D.; Emma Fisher, Ph.D.

Date: July, 2019

Empirical review statusInsufficient Evidence: Existing meta-analyses are not of sufficient quality.

Summary of sample characteristics across studies:

 

 

Variable

Example

Child Age

Across trials, there was variability in the age range of children:

  1. Toddler to Adolescence (0-14 years) (Seid et al., 2010)

 

  1. Elementary to Adolescence (5-16 years) (Nansel et al., 2012; Wade et al., 2005; Wade et al., 2006)

 

  1. Adolescence (11-18 years) (Sahler et al., 2013; Wade et al., 2011)

 

 

Child Sex

All trials enrolled both male and female children

Parent Sex

Three studies enrolled only mothers (Sahler et al., 2002; Sahler et al., 2005; Sahler et al., 2013). The remaining studies enrolled >90% mothers (e.g., Seid et al., 2010; Wade et al., 2005).

 

Family Ethnicity/Race

The majority of trials enrolled primarily Caucasian/Non-Hispanic families. In two trials, participants were primarily Hispanic (Sahler et al., 2013; Seid et al., 2010).

Therapist type

In the majority of trials, treatment was delivered by master’s level therapists or Ph.D. students.

Presenting problem

  1. Asthma: Seid et al., 2010
  2. Cancer: Sahler et al., 2002; Sahler et al., 2005; Sahler et al., 2013
  3. Diabetes: Nansel et al., 2012
  4. Heart Disease: McCusker et al., 2010
  5. Traumatic Brain Injury: Wade et al., 2005; Wade et al., 2006; Wade et al., 2011

Socioeconomic status

In the majority of trials, average socioeconomic status of families was middle to upper class. In a few trials, families were from predominantly lower socioeconomic backgrounds (e.g., Nansel et al., 2012; Sahler et al., 2013; Seid et al., 2010)

Language

In two trials, the intervention was delivered in English and Spanish (Sahler et al., 2005; Sahler et al., 2013; Seid et al., 2010). In all other trials the intervention was delivered in English.

 

 

Brief summary of treatment:

  • Basic premise: Adaptation to the child’s chronic medical condition is influenced by the interaction between social/environmental, cognitive, behavioral, and emotional factors.
  • Essence of therapy: Cognitive-behavioral therapy includes a range of techniques that promote identifying, challenging and modifying maladaptive or negative thoughts and behaviors that interfere with adjustment to and management of the child’s medical condition.
  • Length: Treatment duration for children: 0-12 hours. Treatment duration for parents: 2-16 hours.

 

Treatment resources:

Treatment Manual Available For Purchase
Cognitive-Behavioral Therapy for Chronic Pain in Children and Adolescents (Palermo, 2012)

Self-Help Books
Managing Your Child’s Chronic Pain (Palermo & Law, 2015)
When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress, and Break the Cycle of Chronic Pain (Coakley, 2016)

Worksheets/Handouts
See Worksheets/Handouts in Cognitive-Behavioral Therapy for Chronic Pain in Children and Adolescents (Palermo, 2012)

 

Clinical Trials, Systematic Reviews, and Meta-Analyses:

Clinical Trials:

  1. Ahari, G. S., Younesi, J., Borjali, A., & Damavandi, S. A. (2012). The effectiveness of group hope therapy on hope and depression of mothers with children suffering from cancer in Tehran. Iranian Journal of Cancer Prevention, 5(4), 183-188.
  2. Ambrosino, J. M., Fennie, K., Whittemore, R., Jaser, S., Dowd, M. F., & Grey, M. (2008). Short-term effects of coping skills training in school-age children with type 1 diabetes. Pediatr Diabetes, 9(3 Pt 2), 74-82. doi: 10.1111/j.1399-5448.2007.00356.xPDI356 [pii]
  3. Barakat, L. P., Schwartz, L. A., Salamon, K. S., & Radcliffe, J. (2010). A family-based randomized controlled trial of pain intervention for adolescents with sickle cell disease. J Pediatr Hematol Oncol, 32(7), 540-547. doi: 10.1097/MPH.0b013e3181e793f9
  4. Barry, J., & von Baeyer, C. L. (1997). Brief cognitive-behavioral group treatment for children's headache. Clin J Pain, 13(3), 215-220.
  5. Duarte, M. A., Penna, F. J., Andrade, E. M. G., Cancela, C. S. P., Neto, J. C. A., & Barbosa, T. F. (2006). Treatment of nonorganic recurrent abdominal pain: Cognitive-behavioral family intervention. Journal of Pediatric Gastroenterology and Nutrition, 43, 59-64.
  6. Hoekstra-Weebers, J. E., Heuvel, F., Jaspers, J. P., Kamps, W. A., & Klip, E. C. (1998). Brief report: an intervention program for parents of pediatric cancer patients: a randomized controlled trial. J Pediatr Psychol, 23(3), 207-214.
  7. Janicke, D. M., Mitchell, M. J., Quittner, A. L., Piazza-Waggoner, C., & Stark, L. J. (2008). The impact of behavioral intervention on family interactions at mealtime in pediatric cystic fibrosis. Children’s Health Care, 37, 49-66.
  8. Kazak, A. E., Alderfer, M. A., Barakat, L. P., Streisand, R., Simms, S., Rourke, M. T., . . . Cnaan, A. (2004). Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: A randomized clinical trial. Journal of Family Psychology, 18, 493-504. doi: 10.1037/0893-3200.18.3.493
  9. Lehmkuhl, H. D., Storch, E. A., Cammarata, C., Meyer, K., Rahman, O., Silverstein, J., . . . Geffken, G. (2010). Telehealth behavior therapy for the management of type 1 diabetes in adolescents. J Diabetes Sci Technol, 4(1), 199-208.
  10. Levy, R. L., Langer, S. L., Walker, L. S., Romano, J. M., Christie, D. L., Youssef, N., . . . Whitehead, W. E. (2010). Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol, 105(4), 946-956.
  11. Levy, R. L., Langer, S. L., Walker, L. S., Romano, J. M., Christie, D. L., Youssef, N., . . . Whitehead, W. E. (2013). Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. JAMA Pediatrics, 167, 178-184. doi:10.1001/2014.jamapediatrics.282.
  12. Nelson, K. A., Highstein, G. R., Garbutt, J., Trinkaus, K., Fisher, E. B., Smith, S. R., & Strunk, R. C. (2011). A randomized controlled trial of parental asthma coaching to improve outcomes among urban minority children. Arch Pediatr Adolesc Med, 165(6), 520-526. doi: 10.1001/archpediatrics.2011.57165/6/520 [pii]
  13. Ng, S. M., Li, A. M., Lou, V. W., Tso, I. F., Wan, P. Y., & Chan, D. F. (2008). Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial. Fam Process, 47(1), 115-130.
  14. Palermo, T. M., Wilson, A. C., Peters, M., Lewandowski, A., & Somhegyi, H. (2009). Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain, 146(1-2), 205-213. doi: 10.1016/j.pain.2009.07.034S0304-3959(09)00419-9 [pii]
  15. Robins, P. M., Smith, S. M., Glutting, J. J., & Bishop, C. T. (2005). A randomized controlled trial of a cognitive-behavioral family intervention for pediatric recurrent abdominal pain. Journal of Pediatric Psychology, 30, 397-408. doi:10.1093/jpepsy/jsi063.
  16. Sassmann, H., de Hair, M., Danne, T., & Lange, K. (2012). Reducing stress and supporting positive relations in families of young children with type 1 diabetes: a randomized controlled study for evaluating the effects of the DELFIN parenting program. BMC Pediatr, 12, 152. doi: 10.1186/1471-2431-12-1521471-2431-12-152 [pii]
  17. Stark, L. J., Janicke, D. M., McGrath, A. M., Mackner, L. M., Hommel, K. A., & Lovell, D. (2005). Prevention of osteoporosis: a randomized clinical trial to increase calcium intake in children with juvenile rheumatoid arthritis. J Pediatr Psychol, 30(5), 377-386. doi: jsi061 [pii]10.1093/jpepsy/jsi061
  18. Stark, L. J., Davis, A. M., Janicke, D. M., Mackner, L. M., Hommel, K. A., Bean, J. A., . . . Kalkwarf, H. J. (2006). A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis. Journal of Pediatrics, 148, 501-507. doi:10.1016/jpeds.2005.11.043
  19. Stark, L. J., Quittner, A. L., Powers, S. W., Opipari, L., Bean, J., Duggan, C., . . . Stallings, V. A. (2009). A randomized clinical trial of behavioral intervention and nutrition education to improve caloric intake ad weight in children with cystic fibrosis. Arch Pediatr Adolesc Med, 163, 915-921. doi:10.1001/archpediatrics.2009.165
  20. Stehl, M. L., Kazak, A. E., Alderfer, M. A., Rodriguez, A., Hwang, W. T., Pai, A. L., . . . Reilly, A. (2009). Conducting a randomized clinical trial of an psychological intervention for parents/caregivers of children with cancer shortly after diagnosis. J Pediatr Psychol, 34(8), 803-816. doi: 10.1093/jpepsy/jsn130jsn130 [pii]
  21. Walders, N., Kercsmar, C., Schluchter, M., Redline, S., Kirchner, H. L., & Drotar, D. (2006). An interdisciplinary intervention for undertreated pediatric asthma. Chest, 129(2), 292-299. doi: 129/2/292 [pii]10.1378/chest.129.2.292

Systematic Reviews and Meta-Analyses:

  1. Eccleston, C., Fisher, E., Law, E. F., Bartlett, J., & Palermo, T. M. (2015). Psychological therapies for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews 2015, Issue 4.
  2. Eccleston, C., Palermo, T.M., Fisher, E., & Law, E. F. (2012). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews. Issue 8.
  3. Law, E.F., Fisher, E., Fales, J., Noel, M., & Eccleston, C. (2014). Systematic review and meta-analysis of parent and family-based interventions for children and adolescents with chronic medical conditions. Journal of Pediatric Psychology 39(8), 866-886.

Related Resources

Progress Notes