INDEXING SYSTEM

Youth living with chronic medical conditions and their families face several challenges (e.g., adjustment to a new diagnosis, ongoing daily condition management, coping with potential long-term consequences of illness). Traditional CBT approaches emphasize collaborative problem-solving with a core focus on change. At times, these approaches may feel inaccessible or unhelpful for pediatric patients and their families who are facing illness-related challenges that they cannot change or control. Dialectical behavior therapy integrates CBT-based change interventions with acceptance-based strategies to normalize challenging thoughts and emotions and help individuals feel validated. Medical providers working with pediatric patients and families can also benefit from a DBT-based conceptualization and approach to improve patient/family-provider relationships. This article summarizes the current evidence base for and justifies the use of adaptations of DBT for patients with medical illness. Further, through clinical case examples, it illustrates the use of DBT skills and concepts in improving outcomes for pediatric patients and their families.

RECENT studies estimate that more than 40% of school-aged children and adolescents in the United States have at least one chronic health condition for which they receive specialty care (e.g., asthma, diabetes, epilepsy, orthopedic conditions; National Survey of Children's Health, 2018). In addition to managing their special healthcare needs, many of these children also have diagnosable mental health conditions that may be related (e.g., adjustment disorder following new diagnosis, developmental delays following early open-heart surgery to address a congenital heart defect) or unrelated (e.g., generalized anxiety disorder, Autism spectrum disorder) to their medical condition (Cobham et al., 2020; Merikangas et al., 2015; Spady et al., 2005). Regardless of the relationship between the diagnoses, the presence of comorbid medical and mental health conditions has been found to have negative impacts on healthcare utilization, including increased number of hospital admissions/readmis-sions and increased length of stay (Bardach et al., 2014; Doupnik et al., 2016; Lavigne & Meyers, 2019). Possible explanations for greater healthcare utilization for these youth include lower ability to cope with pain and other symptoms of acute illness, lower adherence to treatment plans, and more care coordination needs (Doupnik et al., 2016). Mental health conditions can impact adherence to medical regimen (e.g., behavioral difficulties leading to medication refusal, low mood impacting motivation to complete complex medical regimen; Modi et al., 2012). Further, the presence of a pediatric health condition also affects caregiver and family (e.g., sibling) emotional health and physical well-being, with caregivers of children with special healthcare needs reporting high rates of mental health concerns (e.g., depression, anxiety, posttraumatic stress symptoms) that would benefit from support (Pilapil et al., 2017).