Acute lymphoblastic leukaemia in children
While actute lymphoblastic leukaemia is the most common cancer in children, the chance of cure is high.
Managing the psychological impact on children
By Rita Princi, B.Psych(Hons), MPsych(Clin), MAPS
Children perceive the world differently to adults. Their cognitive, emotional and social developmental stage will determine how they see the world.
During childhood, children’s thinking can be described as egocentric andimmature, meaning that they will find it difficult to understand why they are in hospital and why they require treatment and express fear about invasive medical procedures. Therefore, spending time in hospital can be very stressful for children and their parents. It is also the case that the levels of distress can impact on how children recover from their illness and treatment.
Psychological treatment can be of assistance to children with ALL, as well as their siblings, their parents, and carers.
Cognitive Behavioural Therapy (CBT) can be useful for children, to help teach emotional recognition and understanding; relaxation, visualisation and problem solving skills; social skills training; and self-esteem and confidence building strategies. CBT can also teach children skills to help them manage gradual exposure to new experiences and anxiety provoking events.
In contrast, family therapy provides parental involvement where parents are taught scenario planning for the expected and unexpected, encouragement of family social activities and ways of modelling less anxious behaviour.
Some of the issues for parents and carers of children with ALL to be aware of include:
- Return to school challenges - Speech pathology and occupational therapy may be worthwhile in helping children who have received chemotherapy to catch up to their peers when they return to learning. Specifically, the child may experience difficulties with auditory processing, fine-motorskills and sensory integration.
- Possible social delays - Children in remission may experience delays to their social development due to having missed essential play-based experiences and social interaction with other children. This may further increase existing anxiety.
- Bullying susceptibility - Unfortunately, there is the risk of a child becoming victim to bullying upon their return to school as a result of differences physically, socially and academically.
- Risk of Post Traumatic Stress Disorder (PTSD) - Approximately 5-21% of childhood cancer survivors have been found to have PTSD. The most common difficulties experienced by children during treatment and post-treatment are heightened anxiety, regression in behaviour, sleep difficulties/nightmares, school avoidance or school phobia, aggressiveness and depression, reintegration problems, school absenteeism due to continuing medical check-ups, academic under-achievement, and difficulties with attention and concentration.
- Impact on siblings - When a brother or sister is unwell, their sibling may also experience anxiety because they feel responsible and guilty (Did it happen because I hated her?), feel sad (for their sibling), feel angry that Mum is always at the hospital, feel anxious about the possibility that their sibling might die, feel lonely and fearful when staying with a babysitter (What if Mum and/or Dad don’t come back?) and worry when they don't understand what adults are discussing. Research has shown that children who received CBT in combination with Family Therapy showed greatest improvement (87%) in ALL treatment outcome. Parental therapy demonstrated that an anxious parent dramatically reduces the effectiveness of CBT for anxious children.
The Leukaemia Foundation can provide advice and support with accessing a psychologist to help your family.