Pre-procedure Evaluation and Psychological Screening of Children and Adolescents in Pediatric Clinics

  • Trude ReinfjellEmail author
  • Trond H. Diseth


Children with severe and/or chronic medical diseases, congenital malformations, and functional impairments have significantly increased risk of developing mental, psychosocial, and family-related problems because of the disease process or different stressful, painful, or traumatic medical treatment procedures. Current studies also demonstrate that pain remains undertreated in children. Hospital personnel need to increase their knowledge of the psychological consequences of serious illness in children so posttraumatic stress reactions can be more effectively prevented. Children present a great challenge because it is necessary to consider their age, developmental level, cognitive and communication skills, previous pain experiences, and associated beliefs. This chapter focuses on factors influencing children’s understanding of and adaptation to severe illness and treatment procedures. We will address factors that are important in the pre-procedure evaluation, discuss relevant interventions and screening tools, and present case examples.


Medical disease Children Hospitalization Treatment procedures Traumatic stress 


  1. Ahmad, A., & Sundelin-Wahlsten, V. (2008). Applying EMDR on children with PTSD. European Child & Adolescent Psychiatry, 17(3), 127–132.Google Scholar
  2. Alderfer, M. A., Labay, L. E., & Kazak, A. E. (2003). Brief report: Does posttraumatic stress apply to siblings of childhood cancer survivors? Journal of Pediatric Psychology, 28(4), 281–286.PubMedGoogle Scholar
  3. Baron, I. S. (2004). Neuropsychological evaluation of the child. New York: Oxford University Press.Google Scholar
  4. Bevan, J. C., Johnston, C., Haig, M. J., Tousignant, G., Lucy, S., Kirnon, V., et al. (1990). Preoperative parental anxiety predicts behavioural and emotional responses to induction of anaesthesia in children. Canadian Journal of Anaesthesia, 37(2), 177–182.PubMedGoogle Scholar
  5. Bibace, R., & Walsh, M. E. (1980). Development of children’s concepts of illness. Pediatrics, 66(6), 912–917.PubMedGoogle Scholar
  6. Bieri, D., Reeve, R. A., Champion, G. D., Addicoat, L., & Ziegler, J. B. (1990). The faces pain scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties. Pain, 41(2), 139–150.PubMedGoogle Scholar
  7. Brenner, E. M., & Salovey, P. (1997). Emotion regulation during childhood. Developmental, interpersonal and individual consideration. In ISDJS (Ed.), Emotional development and emotional intelligence (pp. 168–192). New York: Basic Books.Google Scholar
  8. Brewster, A. B. (1982). Chronically ill hospitalized children’s concepts of their illness. Pediatrics, 69(3), 355–362.PubMedGoogle Scholar
  9. Briere, J. (1997). Psychological assessment of adult post traumatic stress. Washington, DC: American Psychological Association.Google Scholar
  10. Buizer, A. I., de Sonneville, L. M., & Veerman, A. J. (2009). Effects of chemotherapy on neurocognitive function in children with acute lymphoblastic leukemia: A critical review of the literature. Pediatric Blood & Cancer, 52(4), 447–454.Google Scholar
  11. Bush, J. P., Melamed, B. G., Sheras, P. L., & Greenbaum, P. E. (1986). Mother-child patterns of coping with anticipatory medical stress. Health Psychology, 5(2), 137–157.PubMedGoogle Scholar
  12. Butler, R. W., & Copeland, D. R. (2002). Attentional processes and their remediation in children treated for cancer: A literature review and the development of a therapeutic approach. Journal of the International Neuropsychological Society, 8(1), 115–124.PubMedGoogle Scholar
  13. Campbell, L., Clark, M., & Kirkpatrick, S. E. (1986). Stress management training for parents and their children undergoing cardiac catheterization. The American Journal of Orthopsychiatry, 56(2), 234–243.PubMedGoogle Scholar
  14. Campbell, L. A., Kirkpatrick, S. E., Berry, C. C., Penn, N. E., Waldman, J. D., & Mathewson, J. W. (1992). Psychological preparation of mothers of preschool-children undergoing cardiac-catheterization. Psychology & Health, 7(3), 175–185.Google Scholar
  15. Campbell, L. K., Scaduto, M., Sharp, W., Dufton, L., Van Slyke, D., Whitlock, J. A., et al. (2007). A meta-analysis of the neurocognitive sequelae of treatment for childhood acute lymphocytic leukemia. Pediatric Blood & Cancer, 49(1), 65–73.Google Scholar
  16. Cohen, J., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guildford Press.Google Scholar
  17. Cohen, L. L., Lemanek, K., Blount, R. L., Dahlquist, L. M., Lim, C. S., Palermo, T. M., et al. (2008). Evidence-based assessment of pediatric pain. Journal of Pediatric Psychology, 33(9), 939–955. discussion 56–7.PubMedGoogle Scholar
  18. Conners, C. K. (2014). Conners continuous performance test 3rd edition (Conners CPT 3) & Conners continuous auditory test of attention (Conners CATA) – Technical manual. New York/Toronto: MHS.Google Scholar
  19. Corcoran, K., & Foscher, J. (1994). Measures of clinical practice. A source book. 3rd adults. New Yourk: The free press.Google Scholar
  20. de Ruiter, M. A., van Mourik, R., Schouten-van Meeteren, A. Y., Grootenhuis, M. A., & Oosterlaan, J. (2013). Neurocognitive consequences of a paediatric brain tumour and its treatment: A meta-analysis. Developmental Medicine and Child Neurology, 55(5), 408–417.PubMedGoogle Scholar
  21. Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Dellis.Kaplan executive function system (D-KEFS). Examiner’s manual. San Antonio: The Psychological Corporation, Harcourt Assessment Company.Google Scholar
  22. DeLoach Walworth, D. (2005). Procedural-support music therapy in the healthcare setting: A cost-effectiveness analysis. Journal of Pediatric Nursing, 20(4), 276–284.PubMedGoogle Scholar
  23. Diseth, T. H. (2006). Dissociation following traumatic medical treatment procedures in childhood: A longitudinal follow-up. Development and Psychopathology, 18(1), 233–251.PubMedGoogle Scholar
  24. Diseth, T. H. (2014). Kronisk somatisk sykdom og symptomatologi hos barn og unge. In A. A. Dahl, J. H. Loge, & T. F. Aarre (Eds.), Psykiske reaksjoner ved somatisk sykdom (pp. 674–694). Oslo: Cappelen Damm Akademisk.Google Scholar
  25. Diseth, T. H., & Emblem, R. (2017). Long-term psychosocial consequences of surgical congenital malformations. Seminars in Pediatric Surgery Accepted, 26(5), 286–294.Google Scholar
  26. Dow, B. L., Kenardy, J. A., Le Brocque, R. M., & Long, D. A. (2012). The utility of the Children’s revised impact of event scale in screening for concurrent PTSD following admission to intensive care. Journal of Traumatic Stress, 25(5), 602–605.PubMedGoogle Scholar
  27. Edelstein, K., D’Agostino, N., Bernstein, L. J., Nathan, P. C., Greenberg, M. L., Hodgson, D. C., et al. (2011). Long-term neurocognitive outcomes in young adult survivors of childhood acute lymphoblastic leukemia. Journal of Pediatric Hematology/Oncology, 33(6), 450–458.PubMedGoogle Scholar
  28. Eiser, C. (1985). Changes in understanding of illness as the child grows. Archives of Disease in Childhood, 60(5), 489–492.PubMedPubMedCentralGoogle Scholar
  29. Eiser, C. (1998). Practitioner review: Long-term consequences of childhood cancer. Journal of Child Psychology and Psychiatry, 39(5), 621–633.PubMedGoogle Scholar
  30. Farrar, J. T., Young, J. P., Jr., LaMoreaux, L., Werth, J. L., & Poole, R. M. (2001). Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain, 94(2), 149–158.PubMedGoogle Scholar
  31. Ferguson, B. F. (1979). Preparing young children for hospitalization: A comparison of two methods. Pediatrics, 64(5), 656–664.PubMedGoogle Scholar
  32. Flick, R. P., Katusic, S. K., Colligan, R. C., Wilder, R. T., Voigt, R. G., Olson, M. D., et al. (2011). Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics, 128(5), e1053–e1061.PubMedPubMedCentralGoogle Scholar
  33. Frankel, R. M., Quill, T. E., & McDaniel, S. H. (2003). The biopsychological approach: Past, present, future. Rochester: University of Rochester Press.Google Scholar
  34. French, G. M., Painter, E. C., & Coury, D. L. (1994). Blowing away shot pain: A technique for pain management during immunization. Pediatrics, 93(3), 384–388.PubMedGoogle Scholar
  35. Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581–624.PubMedGoogle Scholar
  36. Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior rating inventory of executive function (BRIEF): Professional manual. Lutz: Psychological Assessment Resources.Google Scholar
  37. Gjems, S., & Diseth, T. H. (2011). Somatic illness and psychological trauma in children: Prevention and treatment strategies. Tidsskrift for Norsk Psykologforening, 48, 857–862.Google Scholar
  38. Goldschneider, K. R., Cravero, J. P., Anderson, C., Bannister, C., Hardy, C., Honkanen, A., et al. (2014). The Pediatrician’s role in the evaluation and preparation of pediatric patients undergoing anesthesia. Pediatrics, 134(3), 634–641.Google Scholar
  39. Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.PubMedGoogle Scholar
  40. Goodman, R. (1999). The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791–799.PubMedGoogle Scholar
  41. Harmsen, W. J., Aarsen, F. J., van der Cammen-van Zijp, M. H., van Rosmalen, J. M., Wijnen, R. M., Tibboel, D., et al. (2016). Developmental problems in patients with oesophageal atresia: A longitudinal follow-up study. Archives of Disease in Childhood. Fetal and Neonatal Edition, 102(3), F214–F219.PubMedGoogle Scholar
  42. Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin card setting test manual: Revised and expanded. Odessa: Psychological Assessment Resources.Google Scholar
  43. Heyerdahl, S. (2003). SDQ – Strength and Difficulties Questionnaire: En orientering om et nytt spørreskjema for kartlegging av mental helse hos barn og unge, brukt i UNGHUBRO, OPPHED og TROFINN. Norsk Epidemiologi, 13(1), 127–135.Google Scholar
  44. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41(3), 209–218.PubMedGoogle Scholar
  45. Hutchinson, A. D., Pfeiffer, S. M., & Wilson, C. (2017). Cancer-related cognitive impairment in children. Current Opinion in Supportive and Palliative Care, 11(1), 70–75.PubMedGoogle Scholar
  46. Huynh, M. E., Vandvik, I. H., & Diseth, T. H. (2008). Hypnotherapy in child psychiatry: The state of the art. Clinical Child Psychology and Psychiatry, 13(3), 377–393.PubMedGoogle Scholar
  47. Jay, S. M., Elliott, C. H., Katz, E., & Siegel, S. E. (1987). Cognitive-behavioral and pharmacologic interventions for childrens’ distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55(6), 860–865.PubMedGoogle Scholar
  48. Kahalley, L. S., Conklin, H. M., Tyc, V. L., Hudson, M. M., Wilson, S. J., Wu, S., et al. (2013). Slower processing speed after treatment for pediatric brain tumor and acute lymphoblastic leukemia. Psychooncology, 22(9), 1979–1986.PubMedPubMedCentralGoogle Scholar
  49. Kain, Z. N., Wang, S. M., Mayes, L. C., Caramico, L. A., & Hofstadter, M. B. (1999). Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesthesia and Analgesia, 88(5), 1042–1047.PubMedGoogle Scholar
  50. Kassam-Adams, N. (2006). Introduction to the special issue: Posttraumatic stress related to pediatric illness and injury. Journal of Pediatric Psychology, 31(4), 337–342.PubMedGoogle Scholar
  51. Kazak, A. E., & Noll, R. B. (2015). The integration of psychology in pediatric oncology research and practice: Collaboration to improve care and outcomes for children and families. The American Psychologist, 70(2), 146–158.PubMedGoogle Scholar
  52. Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006). An integrative model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 31(4), 343–355.PubMedGoogle Scholar
  53. Krull, K. R., Okcu, M. F., Potter, B., Jain, N., Dreyer, Z., Kamdar, K., et al. (2008). Screening for neurocognitive impairment in pediatric cancer long-term survivors. Journal of Clinical Oncology, 26(25), 4138–4143.PubMedGoogle Scholar
  54. Krull, K. R., Brinkman, T. M., Li, C., Armstrong, G. T., Ness, K. K., Srivastava, D. K., et al. (2013). Neurocognitive outcomes decades after treatment for childhood acute lymphoblastic leukemia: A report from the St Jude lifetime cohort study. Journal of Clinical Oncology, 31(35), 4407–4415.PubMedPubMedCentralGoogle Scholar
  55. Kunin-Batson, A., Kadan-Lottick, N., Zhu, L., Cox, C., Bordes-Edgar, V., Srivastava, D. K., et al. (2011). Predictors of independent living status in adult survivors of childhood cancer: A report from the childhood Cancer Survivor Study. Pediatric Blood & Cancer, 57(7), 1197–1203.Google Scholar
  56. LeRoy, S., Elixson, E. M., O’Brien, P., Tong, E., Turpin, S., Uzark, K., et al. (2003). Recommendations for preparing children and adolescents for invasive cardiac procedures: A statement from the American Heart Association Pediatric Nursing Subcommittee of the Council on cardiovascular nursing in collaboration with the Council on Cardiovascular Diseases of the Young. Circulation, 108(20), 2550–2564.PubMedGoogle Scholar
  57. Lindheim, M. O., & Helgeland, H. (2017). Hypnosis training and education: Experiences with a Norwegian one-year education course in clinical hypnosis for children and adolescents. The American Journal of Clinical Hypnosis, 59(3), 282–291.PubMedGoogle Scholar
  58. McGrath, P. J., & Frager, G. (1996). Psychological barriers to optimal pain management in infants and children. The Clinical Journal of Pain, 12(2), 135–141.PubMedGoogle Scholar
  59. Morton, N. S. (1997). Pain assessment in children. Paediatric Anaesthesia, 7(4), 267–272.PubMedGoogle Scholar
  60. Myant, K. A., & Williams, J. M. (2005). Children’s concepts of health and illness: Understanding of contagious illnesses, non-contagious illnesses and injuries. Journal of Health Psychology, 10(6), 805–819.PubMedGoogle Scholar
  61. Peterson, C. C., Johnson, C. E., Ramirez, L. Y., Huestis, S., Pai, A. L., Demaree, H. A., et al. (2008). A meta-analysis of the neuropsychological sequelae of chemotherapy-only treatment for pediatric acute lymphoblastic leukemia. Pediatric Blood & Cancer, 51(1), 99–104.Google Scholar
  62. Reinfjell, T., Diseth, T. H., Veenstra, M., & Vikan, A. (2006). Measuring health-related quality of life in young adolescents: Reliability and validity in the Norwegian version of the Pediatric quality of life inventory 4.0 (PedsQL) generic core scales. Health and Quality of Life Outcomes, 4, 61.PubMedPubMedCentralGoogle Scholar
  63. Reinfjell, T., Diseth, T. H., & Vikan, A. (2007). Children and cancer: Children’s adjustment to and understanding of their cancer. Tidsskrift for Norsk Psykologforening, 44, 724–734.Google Scholar
  64. Richter, N. C. (1984). The efficacy of relaxation training with children. Journal of Abnormal Child Psychology, 12(2), 319–344.PubMedGoogle Scholar
  65. Robinson, K. E., Kuttesch, J. F., Champion, J. E., Andreotti, C. F., Hipp, D. W., Bettis, A., et al. (2010). A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors. Pediatric Blood & Cancer, 55(3), 525–531.Google Scholar
  66. Robinson, K. E., Fraley, C. E., Pearson, M. M., Kuttesch, J. F., Jr., & Compas, B. E. (2013). Neurocognitive late effects of pediatric brain tumors of the posterior fossa: A quantitative review. Journal of the International Neuropsychological Society, 19(1), 44–53.PubMedGoogle Scholar
  67. Rodenburg, R., Benjamin, A., de Roos, C., Meijer, A. M., & Stams, G. J. (2009). Efficacy of EMDR in children: A meta-analysis. Clinical Psychology Review, 29(7), 599–606.PubMedGoogle Scholar
  68. Saha, A., Salley, C. G., Saigal, P., Rolnitzky, L., Goldberg, J., Scott, S., et al. (2014). Late effects in survivors of childhood CNS tumors treated on head start I and II protocols. Pediatric Blood & Cancer, 61(9), 1644–1652. quiz 53-72.Google Scholar
  69. Salmon, K., & Pereira, J. K. (2002). Predicting children’s response to an invasive medical investigation: The influence of effortful control and parent behavior. Journal of Pediatric Psychology, 27(3), 227–233.PubMedGoogle Scholar
  70. Sander Wint, S., Eshelman, D., Steele, J., & Guzzetta, C. E. (2002). Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Oncology Nursing Forum, 29(1), E8–E15.PubMedGoogle Scholar
  71. Shapiro, F. (2001). Eye movement desensitization and reprocessing. Basic principles, protocols and procedures. New York: Guilford Press.Google Scholar
  72. Srouji, R., Ratnapalan, S., & Schneeweiss, S. (2010). Pain in children: Assessment and nonpharmacological management. Int J Pediatr, 2010, 1–11.Google Scholar
  73. Stallard, P. (2006). Psychological interventions for post-traumatic reactions in children and young people: A review of randomised controlled trials. Clinical Psychology Review, 26(7), 895–911.PubMedGoogle Scholar
  74. Stuber, M. L. (1996). Psychiatric sequelae in seriously ill children and their families. The Psychiatric Clinics of North America, 19(3), 481–493.PubMedGoogle Scholar
  75. Stuber, M. L., Shemesh, E., & Saxe, G. N. (2003). Posttraumatic stress responses in children with life-threatening illnesses. Child and Adolescent Psychiatric Clinics of North America, 12(2), 195–209.PubMedGoogle Scholar
  76. Stuber, M. L., Schneider, S., Kassam-Adams, N., Kazak, A. E., & Saxe, G. (2006). The medical traumatic stress toolkit. CNS Spectrums, 11(2), 137–142.PubMedGoogle Scholar
  77. Sun, L. (2010). Early childhood general anaesthesia exposure and neurocognitive development. British Journal of Anaesthesia, 105(Suppl 1), i61–i68.PubMedPubMedCentralGoogle Scholar
  78. Tak, J. H., & van Bon, W. H. (2006). Pain- and distress-reducing interventions for venepuncture in children. Child: Care, Health and Development, 32(3), 257–268.Google Scholar
  79. Tsze, D. S., von Baeyer, C. L., Bulloch, B., & Dayan, P. S. (2013). Validation of self-report pain scales in children. Pediatrics, 132(4), e971–e979.PubMedPubMedCentralGoogle Scholar
  80. Uman, L. S., Chambers, C. T., McGrath, P. J., & Kisely, S. (2006). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 4, CD005179.Google Scholar
  81. Utens, E. M., Versluis-Den Bieman, H. J., Verhulst, F. C., Witsenburg, M., Bogers, A. J., & Hess, J. (2000). Psychological distress and styles of coping in parents of children awaiting elective cardiac surgery. Cardiology in the Young, 10(3), 239–244.PubMedGoogle Scholar
  82. Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL: Measurement model for the pediatric quality of life inventory. Medical Care, 37(2), 126–139.PubMedGoogle Scholar
  83. Varni, J. W., Burwinkle, T. M., Rapoff, M. A., Kamps, J. L., & Olson, N. (2004). The PedsQL in pediatric asthma: Reliability and validity of the pediatric quality of life inventory generic core scales and asthma module. Journal of Behavioral Medicine, 27(3), 297–318.PubMedGoogle Scholar
  84. Varughese, A. M., Nick, T. G., Gunter, J., Wang, Y., & Kurth, C. D. (2008). Factors predictive of poor behavioral compliance during inhaled induction in children. Anesthesia and Analgesia, 107(2), 413–421.PubMedGoogle Scholar
  85. Vatne, T. M., Slaugther, L., & Ruland, C. M. (2010). How children with cancer communicate and think about symptoms. Journal of Pediatric Oncology Nursing, 27(1), 24–32.PubMedGoogle Scholar
  86. Vatne, T. M., Ruland, C. M., Ornes, K., & Finset, A. (2012). Children’s expressions of negative emotions and adults’ responses during routine cardiac consultations. Journal of Pediatric Psychology, 37(2), 232–240.PubMedGoogle Scholar
  87. Vessey, J. A., Carlson, K. L., & McGill, J. (1994). Use of distraction with children during an acute pain experience. Nursing Research, 43(6), 369–372.PubMedGoogle Scholar
  88. Vikan, A. (1988). Barns oppfatning av medisinske tiltak. In: P.E. Mjaavatn (Ed.). Barn. Nytt fra forskning om barn i Norge. Nr. 3. Norsk senter for barneforskningGoogle Scholar
  89. Walsh, K. S., Paltin, I., Gioia, G. A., Isquith, P., Kadan-Lottick, N. S., Neglia, J. P., et al. (2015). Everyday executive function in standard-risk acute lymphoblastic leukemia survivors. Child Neuropsychology, 21(1), 78–89.PubMedGoogle Scholar
  90. Wechsler, D. (2014). Wechsler intelligence scale for children (5th ed.). San Antonio: NCS Pearson.Google Scholar
  91. Weiss, D., & Marmar, C. (1997). The impact of event scale – revised. In J. K. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD. New York: Guilford.Google Scholar
  92. Zeltzer, L. K., & Zeltzer, P. M. (2016). Pain in children & young adults. The journey back to normal. Encino: Shilysca Press.Google Scholar
  93. Zeltzer, L. K., Recklitis, C., Buchbinder, D., Zebrack, B., Casillas, J., Tsao, J. C., et al. (2009). Psychological status in childhood cancer survivors: A report from the childhood Cancer Survivor Study. Journal of Clinical Oncology, 27(14), 2396–2404.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Department of Child and Adolescent PsychiatrySt. Olavs University HospitalTrondheimNorway
  3. 3.Section for Psychosomatics and CL-Child Psychiatry, Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway
  4. 4.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway

Personalised recommendations