Download Introduction to Pediatric Psychology

Introduction to Pediatric
Psychology
Laura Williams, M.S.
November 15, 2005
PSY 4930
What is Pediatric Psychology?

Concerned with physical health and illness of
children and the relationship between
psychological/behavioral factors and health,
illness, and disease.
 “Pediatric Psychology” first coined in 1967 by
Logan Wright, “dealing primarily with children
in a medical setting which is nonpsychiatric in
nature” (p. 323)
Roots of Pediatric Psychology
Pediatric Psychology
Clinical Child Psychology
Developmental Considerations
Importance of the family
Health Psychology
Interaction between health and
psychological functioning
Clinical Activities: Settings

Inpatient medical units
– Consultation/liaison services
– Medical units such as hem/onc, burn, PICU

Medical outpatient clinics
– Private pediatric practices
– Clinics such as craniofacial, endocrinology

Outpatient psychology clinics
Clinical Activities: Settings

Specialty clinics
– Physical rehabilitation centers, Child study
centers

Camps or groups
– Camps for children with chronic illness
Types of Issues

Problems related to pediatric conditions
– Adjustment to disease
– Adherence
– Coping with procedural pain

Mental health problems arising in medical units
– Behavior problems while hospitalized
– Bereavement
– Reintegration into school after hospitalization
Types of Issues

General mental health concerns
 Programs for health promotion and early
intervention
– Programs to increase physical activity
– Early intervention with high-risk infants

Mental retardation and developmental disabilities
– Assess, train, and educate parents and professionals

Education/consultation for physicians
 Public health and public policy
Peds Psych Cases
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
 Example Four: Oppositional behavior on the
Bone Marrow Unit

It Looks Physical, But is it?

The pediatric psychologist is often called
on by physicians to determine whether
psychological factors are contributing to
or causing a child problems
 DSM-IV diagnostic categories of:
– Somatization Disorders
– Conversion Disorders
– Psychological Factors Affecting Medical
Condition
Somatization Disorder

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

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 Factors
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
– Example:


Depression and diabetes
Needle phobia and diabetes
Considerations in
Psychological/Medical Links

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 an existing
medical symptoms

There is a difference between correlation 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
Psych Problems Due to Medical
Conditions

Depression, anxiety or other psychological issues can
result from dealing with chronic illnesses or stressful
medical conditions
– coping with disorders such as cancer, cystic fibrosis,
craniofacial disorders
– having to undergo painful treatments such as burn patients

These child may often benefit from therapy
 Parents of these children may also need help in coping
with these types of conditions in their children
Examples of Peds Psych.
Practice

Transplant Evaluations
 Diabetes Clinic
 Craniofacial Clinic
Transplantation Evaluations

Pediatric psychologists work with children
being considered for transplantation
– bone marrow transplants, heart transplants, lung
transplants, kidney transplants

Determining whether the child/family is a
good candidate for a transplant
– Assessment of medical and psychosocial issues
that contribute to the overall decision making
process
Issues to Consider in PreTransplant Evaluation







Presence of major psychological issues in child or parent that
could compromise maintenance of the transplant
Knowledge of what is involved in the transplant process
Motivation for transplantation
Barriers to adherence—past behavior best predicts future
behavior
Stress and coping
Social support
Example of Issues:
– 5 Year Old (bone marrow)
Pediatric Endocrinology Clinic

Outpatient tertiary care clinic
 Psychologist serves as a consultant in a
multidisciplinary team
–
–
–
–
–
Pediatric endocrinologist
Nurses, nurse practitioners
Diabetes educators
Nutritionists
Residents, fellows
Pediatric Endocrinology Clinic

Most patients have type 1 diabetes (but also
type 2 and other endocrine disorders)
 Physician refers patients for:
– Adjustment difficulties
– Poor functioning (academic, behavioral, family,
emotional)
– Poor adherence/diabetes control
Pediatric Endocrinology Clinic

Psychologist conducts brief assessments (15-30
minutes) and provides feedback to the family and
physician
 Family feedback
– Referrals
– Behavioral recommendations
– Problem solving

Physician feedback
– Referrals
– Prognosis
– Treatment regimen change?
Peds Endo Consult

Information collected about:
– Diabetes care
– Emotional functioning
– Academic functioning
– Behavioral functioning
– Social functioning
Pediatric Endocrinology
Consult: Typical Issues

Poor adherence
– Inappropriate level of responsibility for child
– Overbearing parent
– Arguing about the diabetes regimen
– Poor understanding of diabetes regimen
– Stressors/life events impact adherence

Emotional, Academic, Social, Behavioral
functioning
– Poor functioning related to diabetes care or other issues
Craniofacial Clinic

Clinic for children with genetic craniofacial
abnormalities
– Cleft lip and/or palate, craniosynostosis,
hemifacial microsomia

Psychologist is a member of an
interdisciplinary team including:
– Physicians, general surgeons, plastic surgeons,
dentists, oral surgeons, nurse, social worker,
insurance representative, orthodontists
Craniofacial Clinic

Psychologist conducts a brief assessment of
every patient
 Issues assessed:
–
–
–
–
Medical issues
Social functioning
Development
Academic, psychological, and behavioral
functioning
Major Developments in
Pediatric Psychology

APA Division Status
– 2001: The Society of Pediatric Psychology
–
–
–
–
became Division 54 in APA
http://apa.org/divisions/div54/
Differentiated from clinical child, clinical, and
health psychology
Made the field more recognized and viable
Led to collaborations with the American
Academy of Pediatrics
Major Developments

Managed Care and Reimbursement
– Has negatively affected delivery of services
– Many peds psych services are not covered by
insurance:



Pain management
Interventions to increase adherence
Work on multidisciplinary teams
Response to Managed Care

Medical Cost Offset Research
– “The cost of pediatric psychology services
would be ‘offset’ by savings in medical
expedenditures” (Roberts, Mitchell, & McNeal, 2003, p. 14)
 This research is somewhat controversial
Major Developments

Primary Care
– Pediatric psychologists are moving away from
university-based hospitals
– Focusing more on primary care intervention
and prevention activities
Major Developments

Empirically supported treatments
– Disciplines of medicine and psychology are
placing more emphasis on ESTs
– Journal of Pediatric Psychology EST reviews:



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Regimen adherence
Nocturnal enuresis
Feeding problems
Pain
EST criteria

Reports detailed info about participants
 Randomized or single-case design
 Detailed description of treatment approach
(usually with a treatment manual)
 Replication by independent researchers

Goal: the determine the most effective
treatment for specific mental disorders
Child Health Conference 2006

http://www.childhealthpsychology.com/
 . . . provides a national forum for sharing
current research findings in the area of Child
Health/Pediatric Psychology. Additional
objectives include facilitating advances in
clinical practice and in the training of Pediatric
Psychologists. The conference is designed for
psychologists, physicians, nurses, physical
therapists, occupational therapists, social
workers, and other professionals involved in
children's health care.