Download Pediatric Psychology: A Cursory Overview

Pediatric Psychology: An Overview
James H. Johnson, PhD, ABPP
University of Florida
Overview of Pediatric Psychology
• Pediatric Psychology is closely allied with Clinical
Child Psychology.
• Also with Health Psychology.
• Concerned with physical health and illness of children
and the relationship between psychological/behavioral
factors and health, illness, and disease.
• Settings in which Pediatric Psychologists work
include Hospitals, Clinics, Pediatric Practices,
Developmental Centers, and HMO’s.
• They function in various roles – Consultant,
diagnostician, therapist, information resource.
Examples of Ped Psych Activities
• Much of the work of the Pediatric Psychologist
is with hospitalized inpatients
• This can involve assessment/consultation
and/or short term intervention.
• Example One: The boy who couldn’t stop
crying.
• Example Two: The girl who was starving
herself.
• Example Three: The case of Renal Rickets and
Mom’s Jell-O.
It Looks Physical, But is it?
• The pediatric psychologist is often called on by
physicians to determine whether psychological
factors are contributing to child problems.
• Of relevance are the DSM IV diagnostic
categories of;
– Somatization Disorders
– Conversion Disorders
– Psychological Factors Affecting Medical Condition
Somatization Disorder: Diagnostic
Criteria
• History of many physical complaints that occur over a
period of years and result in treatment being sought or
significant impairment in functioning.
• Following symptoms have been displayed
–
–
–
–
Four pain symptoms
Two GI symptoms
One sexual symptom
One psuedoneurological symptom
• Symptoms cannot be fully explained by known medical
condition or substance use.
• If medical condition is present, symptoms are beyond
that expected for condition.
Conversion Disorder
• A primary feature of Conversion Disorder is having
one or more symptoms or deficits affecting voluntary,
motor or sensory functions that suggest a
neurological or other general medical condition (and
causes distress or impairment).
• Psychological factors are judged to be associated with
the symptom or deficit because the initiation or
exacerbation of the symptoms or deficit is preceded by
conflicts or other stressors.
• Symptom not fully explained by a general medical
condition or substance or culture.
Psychological Factor Affecting
Medical Condition
• A general medical condition is present.
• Psychological factors adversely affect the
medical condition in one of the following
ways;
– The factors have influenced the course of the
medical condition - as shown by a close temporal
relationship between psychological factors and the
development or exacerbation, or delayed recovery
from the condition.
Psychological Factor Affecting
Medical Condition
– The factors interfere with the treatment of
medical condition
– The factors cause additional health risks
– Stress-related physiological responses
precipitate or exacerbate symptoms of the
general medical condition
Considerations in Documenting
Psychological/Medical Links
• In some cases with some medical disorders it is
difficult to assess and find the real cause of the
symptoms you are being consulted about.
• The fact that psychological factors are found to
exist does not necessarily mean that they are
causally related to existing medical symptoms
• Remember the issue about correlations and
causation?
Things to Look For
• Do psychologically relevant factors (eg., trauma, stress,
life disruptions, etc.) precede onset.
• Do these factors exacerbate “medical” symptoms.
• Is it possible to find evidence for secondary gain
resulting from the “medical symptom” or “disorder”.
• Be cautions of “as yet undiagnosed” medical conditions
that may really account for symptoms.
• Cases referred for evaluation often turn out to have
some sort of physical problem.
The Case of Dr. X’s Patient
Psychological Problems Resulting
FROM Medical Conditions
• Depression, anxiety or other psychological issues can
result from dealing with chronic illnesses or stressful
medical conditions;
• Examples include children coping with disorders such
as cancer, cystic fibrosis, craniofacial disorders, etc.
• Also included would be children who are having to
undergo painful treatments such as burn patients.
• These children may often benefit from therapy.
• Parents of these children may also need help in coping
with these types of conditions in their children
Transplantation and Implantation
• A major area of involvement for many pediatric
psychologists is working with children being
considered for transplantation.
• Examples include bone marrow transplants, heart
transplants, lung transplants, kidney transplants,
etc.
• Pediatric psychologists often become involved in
determining whether the child/family is a good
candidate for a transplant.
• These assessments involve looking at both
medical and psychosocial issues that may have to
do with the possible outcomes of transplantation.
Issues to Consider in Pre-Transplant
Evaluation
• Presence of major psychological issues in child or
parent that could compromise maintenance of the graft.
• Knowledge of what is involved in the transplant
process.
• Motivation for transplantation
• Challenges to compliance: Past history predicts future
behavior.
• Stress and Coping and Support
• Example of Issues;
– : 3 Year Old (bone marrow)
– 17 Year Old (Kidney)
Pre Cochlear Implant Evaluations:
A Model for Information Gathering