Using hypnosis to help deaf children help themselves: report of two cases.

This is a report of deaf children who demonstrated the ability to quickly learn hypnotic skills and apply them effectively to the management of their problems. The children were taught hypnosis through American Sign Language, their preferred mode of communication. As with hypnosis with hearing children, we focused upon induction with fantasy and imaginative involvement, creation in imagination of a metaphor for, or imagery of, the desired outcome, and associated sense of pride (ego-strengthening), positive expectation, and teaching self-hypnosis to emphasize the importance of repeated, daily practice. Case examples presented are an 11-year-old deaf girl who used hypnosis to eliminate multiple warts, and a 9-year-old deaf boy with mild developmental disability whose self-hypnosis skills were applied to the management of myoclonus. In the former, the clinician is also the sign language communicator and in the latter, a professional sign language interpreter and parent are both intimately involved in the communication and hypnosis process.

Facilitating facilitators' facilitation: experience with a model for teaching leaders of hypnosis practice groups.

We developed a 6 hour training seminar for leaders of small group practice sessions integral to introductory hypnosis workshops. It has been offered annually for 3 years to prepare new faculty for our Introductory Workshop. Applicants met specific experience criteria. Participation was limited to 8 to match and model 8 learners/small group in workshops. Learners reviewed principles of adult education, group dynamics, and guidelines for leaders. Each had the opportunity to role-play small group participant and small group leader in two 3 hour evening periods a week apart. Twenty-four learners participated. Some had taught before. Most were new to teaching small groups and desired specific training. Extensive evaluation of the training was integral to the process. Training was evaluated by examining ratings of leaders by participants in our Annual Introductory Workshop. Ratings used the same parameters taught and evaluated during the training seminar. The training curriculum is presented with the results of evaluations of group leaders' performances in the Annual Workshop. Ratings of "experienced" leaders who did not participate in the training are compared to those of newly trained teachers. Leaders with training plus experience were more effective then leaders with many years of experience.

Diurnal and nocturnal enuresis in a 6 year old.

Justin is a 6-year-old boy diagnosed with attention-deficit/hyperactivity disorder who presented with daytime and night-time wetting. He had been toilet trained at the age of 3 years but was back in diapers as a result of the enuresis. His bowel movements were normal. The initial evaluation consisted of a urinalysis, urine culture, serum creatinine level, and renal/bladder ultrasound examination. The urine studies were normal. The serum creatinine level was elevated at 1.0 mg/dL. The ultrasound examination revealed bilateral mild hydronephrosis and a thickened bladder wall. A voiding cystourethrogram was ordered to evaluate anatomy, but Justin would not allow a Foley catheter to be inserted, so the procedure, along with cystoscopy, was performed under anesthesia. Cystoscopy revealed a highly trabeculated bladder, as is seen in either high-grade obstruction or a neurogenic bladder. The cystogram did not show any obstruction or vesicoureteral reflux. Meanwhile, Justin's symptoms continued to increase to the point at which he was constantly wet, and he no longer made any attempts to void on his own. A spinal magnetic resonance imaging study did not show any occult neurologic lesions. Urodynamic studies revealed a high-pressure bladder, poor emptying, and inappropriate voluntary contraction of the striated, urinary sphincter during micturition. Despite institution of anticholinergic medication, psychotherapy, and behavioral therapy, Justin continued to do poorly. He could not tolerate clean intermittent catheterization, and he eventually required a suprapubic tube for urinary drainage and preservation of his kidneys.

Applying hypnosis in a preschool family asthma education program: uses of storytelling, imagery, and relaxation.

A Preschool Asthma Program was conducted 4 times for children 2 to 5 years of age and their parent(s). Twenty-five (25) child-parent(s) participated in the 7-session program. Data were collected prior to participation and again one year after completion of classes. Following participation, physician visits for asthma were reduced (p = 0.0013) and parents reported increased confidence in self-management skills. Symptom severity scores improved significantly after participation (p < 0.001). A possible association was noted between participation in the program and parental expectations or projections of future outcome (0.05 < p < 0.1). No changes were observed in the frequency of asthma episodes or in pulmonary function tests before and after the program. With the hypnotherapeutic approach of imagery, preschoolers developed new cooperation in asthma-care skills, including cooperative and consistent performance of peakflow measurements.

Hypnotherapeutic management of pediatric and adolescent trichotillomania.

Trichotillomania in children is regularly described as analogous to a habit disorder. As such, it is thought at times to be benign in a manner analogous to habits such as thumb sucking and nail biting. It is also considered by some to be an obsessive-compulsive disorder, to be more recalcitrant to intervention, and to be more socially disabling than simple habits, particularly when persistence and intensity eventuate in obvious alopecia. This report presents five cases of trichotillomania in which self-monitoring, dissociative hypnotic techniques, and self-hypnosis (relaxation/mental imagery) practice were used in teaching children successful management of this vexing problem. Specific emphasis is placed on the nature and importance of modifying the described techniques for the personal and specific developmental needs of individual patients.

Hypnobehavioral approaches for school-age children with dysphagia and food aversion: a case series.

The purpose of this article is to describe hypnobehavioral treatment of five school-age children with maladaptive eating behaviors, including functional dysphagia, food aversion, globus hystericus, and conditioned fear of eating (phagophobia). The unique treatment approach described emphasizes the successful use of self-management techniques, particularly hypnosis, by all five children. Common etiological factors, treatment strategies, and proposed mechanisms of change are discussed. To the authors' knowledge, this is the first such case series in the mainstream pediatric literature describing the use of a hypnobehavioral approach for children with these maladaptive eating problems.

The power of words: communicating effectively with young patients.

Communication skills are the cornerstone of the doctor-patient relationship. This article provides clinically helpful hints to practitioners working with children and families. Specific examples of clinical phrases are presented along with alternative phrases that may enhance the clinical process.

"Cyberphysiologic" strategies for children: the clinical hypnosis/biofeedback interface.

This article presents an in-depth discussion of the integrated use of self-hypnosis and biofeedback in the treatment of pediatric biobehavioral disorders. The rationale for integrating these techniques and their similarities and differences are discussed. The concepts of children's imaginative abilities, mastery, and self-regulation are examined as they pertain to these therapeutic strategies. Three case studies are presented that illustrate the integrated use of self-hypnosis and biofeedback in the treatment of children with psychophysiologic disorders. The authors speculate on the specific aspects of these self-regulation or "cyberphysiologic" techniques that appear particularly relevant to positive therapeutic outcomes.

Sleep-terror disorder in children: the role of self-hypnosis in management.

This paper describes four children, ages 8 to 12 years, with frequent, prolonged, or dangerous disorders of arousal. None had any significant psychological or behavioral problems. Each had a polysomnogram that showed sudden arousals out of slow-wave sleep associated with complex behavior. All responded to a short course of imipramine, 20 to 60 mg at bedtime, followed by and in conjunction with training in relaxation and mental imagery (self-hypnosis). Once the correct diagnosis was made, the treatment strategy was to (1) demystify the symptom complex through education, (2) establish prompt control of the symptoms with the use of imipramine, (3) train the children in self-regulation with self-hypnosis, and (4) discontinue the medication while maintaining control of the arousals. Over a 2-3 year follow-up all children remain asymptomatic. This is the first report of successful use of self-hypnosis for the treatment of polysomnogram-proven disorders of arousal in the pediatric population. Also reported are seven additional children who were treated equally successfully with hypnosis without the use of medication.

Emotions in pediatric emergencies: what we know, what we can do.

Emotional reactions are an important, but often ignored, aspect of the pediatric emergency medical encounter. The importance of the family's definition of emergency is discussed along with literature on reaction to trauma, developmental issues, and needs in the emergency encounter. Specific actions are discussed in four categories: (a) recognizing and legitimizing emotions, (b) assessing emotional aspects, (c) responding to emotional needs, and (d) following up with all involved.

Comparison of nebulized terbutaline and subcutaneous epinephrine in the treatment of acute asthma.

Nineteen children who presented for treatment of acute asthma symptoms were studied. They were randomized to receive either subcutaneous epinephrine 0.01 mg/kg (0.3 mg maximum) or nebulized terbutaline 1 mg in 2 mL normal saline. The drugs were administered using the double-blind method. Each patient received either subcutaneous epinephrine with concurrent nebulized normal saline or nebulized terbutaline with a concurrent subcutaneous injection of normal saline. Depending on the patient's clinical status, up to three doses of the same drug and placebo were administered. Pulmonary functions (FEV1, FVC, FEF25-75), heart rate, respiratory rate, and pulmonary index were obtained before treatment, at 20 minutes, and at one hour after the final treatment. Except for the baseline respiratory rate, the mean number of treatments, pulmonary index, heart rate, and respiratory rate (at 20 minutes and one hour) were not statistically different. Pulmonary functions were not significantly different at any time. The one-hour post-treatment pulmonary functions (percentage of predicted normal) for terbutaline and epinephrine were FEV1, 49.2 +/- 18.4% and 49.4 +/- 16.9%; FVC, 72.7 +/- 23.4% and 62.7 +/- 21.6%; and FEF25-75, 31.8 +/- 18.6% and 39.0 +/- 12.2%, respectively. The data presented support our hypothesis that terbutaline by nebulization is at least as effective as epinephrine in the management of children with similar degrees of pulmonary obstruction.

The use of relaxation-mental imagery (self-hypnosis) in the management of 505 pediatric behavioral encounters.

This report assessed outcomes of hypnotherapeutic interventions for 505 children and adolescents seen by four pediatricians over a period of one year and followed from four months to two years. Presenting problems included enuresis, acute pain, chronic pain, asthma, habit disorders, obesity, encopresis, and anxiety. Using strict criteria for determination of problem resolution (e.g., all beds dry) and recognizing that some conditions were intrinsically chronic, the authors found that 51% of these children and adolescents achieved complete resolution of the presenting problem; an additional 32% achieved significant improvement, 9% showed initial or some improvement; and 7% demonstrated no apparent change or improvement. Children as young as three years of age effectively applied self-hypnosis techniques. In general, facility in self-hypnosis increased with age. There was an inverse correlation (p less than 0.001) between clinical success and number of visits, suggesting that prediction of responsivity is possible after four visits or less.

The effect of carbonated beverages on ipecac-induced emesis.

To determine the effect of carbonated beverages on syrup of ipecac, 24 pediatric patients were randomly administered six ounces of water or a carbonated beverage with syrup of ipecac. Changes in the abdominal girth, the volume of emesis, and time of emesis were monitored in all patients. In the carbonated beverage group a significant difference (P less than 0.05) was observed between the baseline and 10-min post-ipecac administration abdominal girth measurements. The time of emesis and volume of emesis were not significantly different in the water or carbonated beverage groups. We conclude that carbonated beverage administration does not alter the effectiveness of syrup of ipecac.