Psychological symptom differences between voiding dysfunction and bladder exstrophy patients in an interdisciplinary pediatric urology clinic.
Jessica Hankinson, Ph.D., Kaushalendra Amatya, Ph.D., Marlo Eldridge, DNP, Rick Ostrander, Ed.D., John Gearhart, M.D..
Johns Hopkins Hospital, Baltimore, MD, USA.
Background: Research on psychosocial functioning among pediatric urology patients indicates that children with voiding dysfunction have significantly higher level of psychological difficulties than do children without urological problems (e.g. Wolfe-Christensen et al., 2012). Additionally, research on pediatric bladder exstrophy-epispadias complex (BEEC) patients also shows that these children present with high levels of anxiety and depression (e.g. Reiner & Gearhart, 2006) and have more difficulties as they get older (e.g. Hankinson et al., 2014). However, research has not assessed the differences in psychological functioning in children with voiding dysfunction and those with BEEC. The current study sought to address this gap in literature by comparing psychological functioning in these two populations using a standardized psychological measure routinely given in an interdisciplinary urology clinic. Materials & Methods: Patients (N= 86 mean age= 9.35 years, 38.3 % female) and their parents completed the Behavioral Assessment System for Children 2nd Edition (BASC2), a measure that evaluates a broad range of internalizing, externalizing, and adaptive functioning difficulties in children, during their urology clinic visit. Additionally, patients’ psychosocial functioning in school was also assessed with teacher report. Demographic information were obtained from medical records. Results: Results indicate that children with voiding dysfunction and BEEC in general display psychological functioning similar to children in the general population. T-tests comparing voiding dysfunction and BEEC children, however, indicate that children with voiding dysfunction have significantly higher levels of hyperactivity, inattention, depression, somatization, atypicality, functional communication deficits, and overall internalizing and externalizing problems per mother’s report. Self-report indicated that children with voiding dysfunction have significantly higher levels of social stress. Teacher report indicated higher levels of atypicality and social withdrawal in voiding dysfunction children. Father’s report did not indicate any significant differences. Conclusions: These results suggest that screening of psychological difficulties pediatric urology patients can inform providers of internalizing, externalizing, and adaptive functioning problems in both of these complex populations. Additionally patients with voiding dysfunction are at higher risk for internalizing, externalizing, and adaptive skills problems compared to BEEC. However there are other difficulties that children with BEEC undergo including coping with surgeries, prolonged incontinence, disclosure, and body image that may not be captured by standard psychological measures. Thus routine screening of psychosocial difficulties in pediatric urology patients in an interdisciplinary clinic can help in early identification and intervention of difficulties. In addition, obtaining information from multiple informants can provide a more complete picture of current psychological functioning. Further clinical and research implications are also discussed.
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