Skip to main content

Advertisement

SpringerLink
Log in

Prospective evaluation of comorbidity and psychosocial need in children and adolescents with anorectal malformations. Part 2: Evaluation of psychosocial need

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Only a few patients with anorectal malformations (ARM) have satisfactory bowel functions. Studies of ARM have reported psychosocial problems in up to 73% of patients. The aim of the current study was to document the psychosocial needs of patients with ARM.

Methods

Between June 2004 and September 2005, 44 patients with ARM were treated; the sample included 30 patients (23 males and 7 females) aged 4–17. To focus on potential psychosocial strain, a comprehensive grading system with a sophisticated perspective of continence, associated malformations, number of surgical interventions and postoperative complications was introduced. For psychosocial screening, the following instruments were used: German “Basis-Dokumentation” (BADO), Impact on Family Scale (IFS), the Strengths and Difficulties Questionnaire (SDQ). All families assessed their own psychosocial needs. An extensive psychosocial programme was provided.

Results

Twenty-three patients were suffering severe burden according to the comprehensive grading system. Nearly half of the families reported increased financial stress, and one-third reported emotional or hyperactivity problems of the child. More than 70% confirmed psychosocial need.

Conclusions

Paediatric surgeons should promote psychosocial support for all patients who suffer severe forms of ARM or its numerous associated malformations as well as for patients undergoing numerous surgical interventions or having many postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Murken JD, Albert A (1976) Genetic counselling in cases of anal and rectal atresia. Prog Pediatr Surg 9:115–118

    PubMed  CAS  Google Scholar 

  2. Piekarsky DH, Stephens FD (1976) The association and embryogenesis of tracheo-oesophageal and anorectal anomalies. Prog Pediatr Surg 9:63–76

    Google Scholar 

  3. Peña A (1995) Anorectal malformations. Semin Pediatr Surg 4(1):35–47

    PubMed  Google Scholar 

  4. Hasse W (1976) Associated malformations with anal and rectal atresiae. Prog Pediatr Surg 9:99–103

    PubMed  CAS  Google Scholar 

  5. Holschneider A, Hutson J, Peña A, Bekhit E, Georgeson K, Iwai N et al (2005) Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 40:1521–1526

    Article  PubMed  Google Scholar 

  6. Holschneider A, Jesch NK, Stragholz E, Pfrommer W (2002) Surgical methods for anorectal malformations from Rehbein to Peña—critical assessment of score systems and proposal for a new classification. Eur J Pediatr Surg 12:73–82

    Article  PubMed  CAS  Google Scholar 

  7. Rintala R, Mildh L, Lindahl H (1994) Fecal continence and quality of life for adult patients with an operated high or intermediate anorectal malformation. J Pediatr Surg 29(6):770–780

    Google Scholar 

  8. Diseth T, Emblem R, Solbraa IB, Vandvik IH (1994) A psychosocial follow up of ten adolescents with low anorectal malformation. Acta Pediatr 83(2):216–221

    Article  CAS  Google Scholar 

  9. Schmiedeke E, Lorenz C (2003) Pubertät verstärkt Problematik bei Stuhlentleeerungsstörungen. Bremer Ärztejournal 6:12–13

    Google Scholar 

  10. Van Kuyk EM, Brugman-Boezeman ATM, Wissink-Essink M, Severijnen RSVM, Festen C, Bleijenberg G (2000) Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study. Pediatr Surg Int 16:317–321

    Article  PubMed  Google Scholar 

  11. Cadman D, Boyle M, Szatmari P, Offord DR (1987) Chronic illness, disability, and mental and social well-being: findings of the Ontario child health study. Pediatrics 79(5):805–813

    PubMed  CAS  Google Scholar 

  12. Wallander JL, Varni JW (1998) Effects of pediatric chronic disorders on child and family adjustment. J Children′s Psychol Psychiatr 39(1):29–46

    Article  CAS  Google Scholar 

  13. Working Group ARM Charité (2005) A comprehensive grading system. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedzin Berlin, Department of Pediatric Surgery, Charité Universitätsmedizin Berlin (unpublished)

  14. Englert E, Jungmann J, Lam L, Wienand F, Poustka F (1998) Die Basisdokumentation Kinder- und Jugendpsychiatrie—Merkmalskatalog der Fachverbände für eine gemeinsame Basisdokumentation für Klinik und Praxis. Spektrum der Psychiatrie und Nervenheilkunde 27:129–146

    Google Scholar 

  15. Stein R, Riessmann C (1980) The development of an impact-on-family-scale: preliminary findings. Med Care 4:465–472

    Article  Google Scholar 

  16. Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from the strengths and difficulties questionnaire (SDQ) scores in child mental health clinics in London and Dhakar. Eur Child Adolesc Psychiatry 9:129–134

    Article  PubMed  CAS  Google Scholar 

  17. Ditesheim J, Templeton JM Jr (1987) Short-term versus long-term quality of life in children following repair of high imperforate anus. J Pediatr Surg 22(7):581–587

    Article  PubMed  CAS  Google Scholar 

  18. Ong N, Beasley SW (1990) Comparison of clinical methods for the assessment of continence after repair of high anorectal anomalies. Pediatr Surg Int 5(4):233–237

    Google Scholar 

  19. Iwai N, Yanagihara J, Tokiwa K, Deguchi E, Takahashi T (1988) Results of surgical correction of anorectal malformations: a 10–30 year follow-up. Annu Surg 207(2):219–222

    Article  CAS  Google Scholar 

  20. Walker L (1989) The role of maternal employment and depression in the psychological adjustment of chronically ill, mentally retarded, and well children. J Pediatr Psychol 14(3):357–370

    Article  PubMed  CAS  Google Scholar 

  21. Wallander JL (1989) Family resources as resistance factors for psychological maladjustment in chronically ill and handicapped children. J Pediatr Psychol 14(2):157–173

    Article  PubMed  CAS  Google Scholar 

  22. Pless IB, Roghman KJ (1971) Chronic illness and its consequences: observations based on three epidemiologic surveys. J Pediatr 79:351–359

    Article  PubMed  CAS  Google Scholar 

  23. Ludman L, Spitz L, Lansdown R (1993) Intellectual development at 3 years of age of children who underwent major neonatal surgery. J Pediatr Surg 28(2):130–134

    Article  PubMed  CAS  Google Scholar 

  24. Spitz RA (1945) An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanal Stud Children 1:53–74

    Google Scholar 

  25. Bowlby J (1951) Maternal care and mental health, vol 2. WHO, Monogramm

  26. Schneider W (1987) Psychosoziale Entwicklungsbedingungen von Kindern und Jugendlichen mit einer organisch bedingten analen Inkontinenz. Praxis Kinderpsychologie und Kinderpsychiatrie 36:56–62

    CAS  Google Scholar 

  27. Troschke J (1974) Das Kind als Patient im Krankenhaus. Eine Auswertung der Literatur zum psychischen Hospitalismus, 3rd edn. Reinhardt, München

    Google Scholar 

  28. Pfeiffer U, Bühligen U, Kleber B (2002) Persönlichkeitsentwicklung chronisch kranker Kinder am Beispiel Analatresie. 8. Deutscher Kongress für Kinder- und Jugendmedizin. Universitätsklinikum Leipzig AöR

  29. Rothbart J, Bemelman WA, Meijerink WJ et al (2001) What is the impact of fecal incontinence on quality of life. Dis Colon Rectum 44(1):67–71

    Article  Google Scholar 

  30. Bai Y, Yuan Z, Wang W et al (2000) Quality of life in children with fecal incontinence after surgically corrected anorectal malformation. J Pediatr Surg 35(3):462–464

    Article  PubMed  CAS  Google Scholar 

  31. Diseth TH, Egeland T, Emblem R (1998) Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung′s disease and low anorectal anomalies. J Pediatr Surg 33(3):468–475

    Article  PubMed  CAS  Google Scholar 

  32. Ludman L, Spitz L (1995) Psychosocial adjustment of children treated for anorectal anomalies. J Pediatr Surg 30(4):495–499

    Article  PubMed  CAS  Google Scholar 

  33. Ludman L, Spitz L, Kiely EM (1994) Social and emotional impact of fecal incontinence after surgery for anorectal anomalies. Arch Dis Childhood 71:194–200

    Article  CAS  Google Scholar 

  34. Eiser C (1990) Psychological effects of chronic disease. J Children Psychol Psychiatr 31(1):85–98

    Article  CAS  Google Scholar 

  35. Herpertz-Dahlmann B, Kruse W, Ziegert B, Neuss A (2002) Psychische Auffälligkeiten von Kindern und Jugendlichen in der allgemeinärztlichen Praxis: Wer ist behandlungsbedürftig? Deutsches Ärzteblatt 99(21):A1436–A1441

    Google Scholar 

  36. Barkmann C, Schulte-Markwort M (2004) Prävalenz psychischer Auffälligkeit bei Kindern und Jugendlichen in Deutschland—ein systematischer Literaturüberblick. Psychiatr Prax 6(31):278–287

    Article  Google Scholar 

Download references

Acknowledgment

Our special thanks to Martina Pech for the assistance with the translation and to Dr. Med. E. Pfeiffer for critical assessment.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    S. Winter, D. Schmidt, K. Lenz & U. Lehmkuhl

  2. Child Centre Maulbronn, Hospital for Social and Neuropaediatrics, Maulbronn, Germany

    E. Jenetzky

  3. Department of Paediatric Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany

    H. Mau & S. Märzheuser

Authors
  1. S. Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Lenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Lehmkuhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Jenetzky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Mau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Märzheuser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Winter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Winter, S., Schmidt, D., Lenz, K. et al. Prospective evaluation of comorbidity and psychosocial need in children and adolescents with anorectal malformations. Part 2: Evaluation of psychosocial need. Pediatr Surg Int 25, 895–900 (2009). https://doi.org/10.1007/s00383-009-2441-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-009-2441-8

Keywords

Search

Navigation