By Lynnda M. Dahlquist (auth.)

Pain is a fancy, multidimensional phenomenon, with physiological, behav­ ioral, emotional, cognitive, and developmental elements (Zeltzer, Barr, McGrath, & Schechter, 1992). To successfully evaluation and deal with discomfort in teenagers, the clini­ cian needs to be in a position to check the original methods those advanced dimensions have interaction for the person baby and combine those dimensions right into a remedy plan. this is a daunting job. the aim of this publication is to supply a framework for conceptualizing soreness difficulties in young ones which can advisor the practitioner in constructing an evaluate and therapy plan that's optimum for the person baby. This booklet isn't in­ tended to be a complete, exhaustive evaluate of the literature on discomfort deal with­ ment in youngsters. There are numerous very good books of this nature (e.g., Bush & Harkins, 1991: McGrath, 1990; Ross & Ross, 1988). as a substitute, this booklet is an at­ tempt to stipulate an speculation trying out strategy of case conceptualizing and deal with­ ment making plans which could aid constitution the duty of sorting throughout the complicated interrelationships that make sure kid's pain.

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Another developmental error in attention diversion is expecting the child to use distraction to manage pain without any adult assistance. This requires a level of autonomy in affect regulation of which many pre-adolescent children are incapable. , Dahlquist, Gil, Armstrong, DeLawyer, Greene, & Wuori, 1986; Elliott & Olson, 1983). This phenomenon most likely reflects the fact that children, especially young children, need adults to help them regulate their affect (Kopp, 1982). Attentional factors also can playa role in recurrent pain syndromes.

For example, the lonely, isolated parent of a child with an intractable pain problem was in daily contact with supportive staff and patients who sympathized with her situation. Even in periods of robust health, this woman looked for signs of pain in her child, often seeking multiple evaluations of minuscule complaints in order to meet her own emotional needs for companionship and attention. On a more simplistic level, it feels good to comfort a child. To quell their tears or hold them close can meet many adults' needs to feel needed and important, not to mention loved.

1 summarizes the general behavioral hypotheses covered in this chapter. The Hypothesis Generation and Testing Worksheet in Appendix A also includes these behavioral hypotheses. 39 6 Developing an Evaluation Plan After an exhaustive list of hypotheses to account for the child's pain has been generated, the next step in the evaluation process involves testing each hypothesis. The therapist collects data from the child, the family, the medical staff, and others in the child's environment, and then examines the accumulated evidence to determine the degree to which each hypothesis is supported or refuted.

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