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Karen Dineen Wagner, MD, PhD
Martin P. Paulus, MD, Marc N. Potenza, MD, PhD, Kara S. Bagot, MD
Facilitating Autism Diagnosis
Andrew J. Schuman, MD
A well-being centered approach expands assessment and treatment for the child’s strengths and opportunities for positive experiences with the family.
SPECIAL REPORT: CHILD & ADOLESCENT PSYCHIATRY
When caring for each unique child, implementing well-being practices are an important addition to therapeutic skills. Addressing and including well-being in our efforts with children better prepares them for the future.1 Effective well-being practices further appear to diminish vulnerability to the impacts of
Karen Dineen Wagner, MD, PhD
Martin P. Paulus, MD, Marc N. Potenza, MD, PhD, Kara S. Bagot, MD
Facilitating Autism Diagnosis
Andrew J. Schuman, MD
What is well-being? It encompasses multiple broad dimensions of quality of life.5 In addition to physical well-being, also it also includes occupational, intellectual, social, and emotional well-being (collectively, POISE). Well-being is not simply the opposite of illness, and it should be thought of on its own axis. One can have high or low symptoms of physical or mental health problems (eg,
Applications in Practice
The
This measure allows clinicians and families to rapidly identify both general domains of strength and weakness, and to recognize specific topics to address within each domain. The clinician can then include well-being within the treatment plan. For example, a low rating in the sleep item, despite stable scores in all other physical domain items, illuminates a target for intervention.
Creating a Well-Being Plan
Several factors can guide providers as they select and prioritize well-being practices for each patient. First, what matters most to this individual and family? More salient and important goals usually take priority. Second, cultural factors influence well-being, including the values, tasks, and aspirations of each well-being domain. Cultural influences shape how different individuals care for their bodies, manage emotions, and choose relationships, and thus guide individual well-being practices and goals. Third, developmental attunement for each individual remains important; interventions for intellectual stimulation will change across the age span, along with age-appropriate skills for physical activity, time management, emotional regulation, and social skills and relationships.
Motivational interviewing approaches are helpful for youth and families to determine whether they are invested in making a change to achieve a goal.7 Usually a small number of goals (1 or 2) agreed upon by the child and parent, and even shared with others, are easiest to accomplish.
Clinical Case Application
“Samantha,” a 14-year-old female, described symptoms consistent with depression. When completing the POISE scale, she described an inability to
In addition to treatment for her depressive symptoms, which might include cognitive behavioral and/or antidepressant treatment, well-being practices may also be helpful to alter Samantha’s current routine as well as her future. Sample interventions are provided in
In this case, a well-being plan might address all of the POISE domains with interventions preferred by Samantha. For example, in the physical domain, she might be receptive to making changes to her bedtime routine to
Often mood symptoms are a priority for child psychiatrists, and replacing unhelpful behaviors is a vital component of treatment.
Concluding Thoughts
Not only can well-being interventions be useful adjuvants to specific treatments for patients’ psychiatric symptoms, but they can also help youth address their unique constellation of symptoms and ingrain healthy practices to enhance their quality of life in multiple domains. The lists of preferred and richer evidence-based strategies will continue to grow, so that ongoing recognition and consideration of well-being can become an effective addition to our care of youth.
Dr Bostic is a professor of clinical psychiatry in the Division of Child and Adolescent Psychiatry at MedStar Georgetown University Hospital, Washington DC. Dr Pustilnik is an assistant professor of psychiatry in the Division of Child and Adolescent Psychiatry at MedStar Georgetown University Hospital. Ms Neuwirth is a medical student at Georgetown University School of Medicine. None of the authors report anything to disclose. Dr Charlot-Swilley is an assistant professor and senior policy associate at the Center for Child and Human Development in the Division of Child and Adolescent Psychiatry at MedStar Georgetown University Hospital.
References
1. Paus T, Keshavan M, Giedd JN.
2. Christner N, Essler S, Hazzam A, Paulus M.
3. Bartels M, Cacioppo JT, van Beijsterveldt TC, Boomsma DI.
4. Slade M.
5. Health-related quality of life: well-being concepts. CDC. October 31, 2018. Accessed September 7, 2021.
6. Pendell R. Wellness vs. wellbeing: what’s the difference? Gallup. March 22, 2021. Accessed August 30, 2021.
7. Draxten M, Flattum C, Fulkerson J.
8. Patkar M. 5 Blinkist alternatives for free book summaries you may not have known. MUO. May 15, 2021. Accessed September 10, 2021.
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