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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