ccintroduction to pediatric psychology

8/13/2019 CCIntroduction to Pediatric Psychology

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Introduction to Pediatric

Psychology

Gregg Selke, Ph.D.

November 14, 2006

PSY 4930


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What is Pediatric Psychology?

Concerned with physical health and illnessof 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 isnonpsychiatric in nature (p. 323)


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Roots of Pediatric Psychology

Clinical Child Psychology

Developmental Considerations

Importance of the family

Health Psychology

Interaction between health and

psychological functioning

Pediatric Psychology


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Defining Features

1. Promotionof healthy behaviors

2. Preventionof problematic health

effects (e.g., unhealthy lifestyles,behavioral patterns.overeating)

Goal: Target behaviors early in life orearly in the onset of a chronic medical

condition


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Clinical Activities: Settings

Specialty clinics

Physical rehabilitation centers, Child study

centers

Camps or groups

Camps for children with chronic illness


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Types of Issues

Problems related to pediatric conditions Adjustment to disease

Adherence

Coping with procedural pain

Mental health problems arising in medicalunits

Behavior problems while hospitalized (e.g.,noncompliance)

Bereavement (Death and Dying issues)

Reintegration into school after hospitalization


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Types of Issues

General mental health concerns

Programs for health promotion and earlyintervention Programs to increase physical activity

Early intervention with high-risk infants

Mental retardation and developmentaldisabilities

Assess, train, and educate parents andprofessionals

Education/consultation for physicians

Public health and public policy


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It Looks Physical, But is it?

The pediatric psychologist is often calledon by physicians to determine whetherpsychological factors are contributing to orcausing a child problems

DSM-IV diagnostic categories of: Somatization Disorders Conversion Disorders

Psychological Factors Affecting MedicalCondition

Feeding and Eating Disorders of Infancy orEarly Childhood Pica, Rumination Disorder, Feeding Disorder of

Infancy and Early Childhood


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Somatization Disorder

History of many physical complaints that occurover a period of years and result in treatmentbeing sought or significant impairment infunctioning.

Following symptoms have been displayed Four pain symptoms

Two GI symptoms

One sexual symptom

One psuedoneurological symptom

Symptoms cannot be fully explained by knownmedical condition or substance use.

If medical condition is present, symptoms arebeyond that expected for condition.


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Conversion Disorder

One or more symptoms or deficits affect ingvo luntary , motor or senso ry func t ionsthat

suggest a neuro logical or o ther general

medica l condi t ion (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 ispreceded by conflicts or other stressors.

Symptom not fully explained by a general medical

condition or substance or culture.


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Psychological Factor Affecting

Medical Condition

A general medical condition is present.

Psychological factors adversely affect the

medical condition in one of the followingways:

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.


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Psychological Factors

Affecting Medical Condition

The factors interfere with the treatment ofmedical condition

The factors cause additional health risks

Stress-related physiological responsesprecipitate or exacerbate symptoms of the

general medical condition Example:

Depression and diabetes

Needle phobia and diabetes


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Diagnostic Criteria for 307.59 Feeding

Disorder of Infancy or Early Childhood

A. Feeding disturbance as manifested bypersistent failure to eat adequately withsignificant failure to gain weight or significant

loss of weight over at least 1 month.B. The disturbance is not due to an associatedgastrointestinal or other general medicalcondition (e.g., esophageal reflux).

C. The disturbance is not better accounted for byanother mental disorder (e.g., RuminationDisorder) or by lack of available food.

D. The onset is before age 6 years.


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Considerations in

Psychological/Medical Links

With some medical disorders it is difficult toassess and find the real cause of thesymptoms you are being consulted about.

The fact that psychological factors arefound to exist does not necessarilymean that they are causally related to

an existing medical symptoms There is a difference between correlation and

causation


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Psych Problems Due to Medical

Conditions Depression, anxiety or other psychological

issues can result from dealing with chronicillnesses or stressful medical conditions coping with disorders such as cancer, cystic fibrosis,

craniofacial disorders

having to undergo painful treatments such as burnpatients

These child may often benefit from therapy Parents of these children may also need help in

coping with these types of conditions in theirchildren


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Things to Look For

Do psychologically relevant factors (eg.,trauma, stress, life disruptions, etc.) precedeonset.

Do these factors exacerbate medicalsymptoms.

Is it possible to find evidence for secondarygain resulting from the medical symptom ordisorder.

Be cautions of as yet undiagnosed medicalconditions that may really account forsymptoms.

Cases referred for evaluation often turn out to

have some sort of physical problem.


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Case Examples

1. Adolescent who had nauseau,

dizziness, and collapsing spells

2. The girl who refused to eat


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Case Examples

Role of Pediatric Psychologist Systematic Assessment of Antecedents

and Consequences (ReinforcementContingencies

Determine effective/noneffective strategiesof treatment team and family

Strategies: Contingent or differential social

attention, shaping and fading procedures,positive reinforcement (verbal and tangiblerewards)

Liaison between PT, OT, Speech, and

family


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Examples of Pediatric

Psychologists on UF ClinicTeams

Transplant EvaluationsDiabetes Clinic

Craniofacial Clinic


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Transplantation Evaluations

Pediatric psychologists work with childrenbeing 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

Contraindicating Factors?


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Issues to Consider in Pre-

Transplant Evaluation

Presence of major psychological issues inchild or parent that could compromisemaintenance of the transplant

Knowledge of what is involved in thetransplant process

Motivation for transplantation

Barriers to adherencepast behavior best

predicts future behavior Stress and coping

Social support


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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


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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


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Psychologist conducts brief assessments (15-30 minutes) and provides feedback to thefamily and physician

Family feedback Referrals Behavioral recommendations

Problem solving

Physician feedback Referrals

Prognosis

Treatment regimen change?


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Peds Endo Consult

Information collected about:

Diabetes care

Emotional functioning

Academic functioning

Behavioral functioning

Social functioning


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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 orother issues


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Craniofacial Clinic

Clinic for children with genetic craniofacial

abnormalities Cleft lip and/or palate

Craniosynostosis Premature fusion of the sutures of the skull

Hemifacial microsomia Malformation of the jaw, cheek and ear associated with

vertebral defects, with deformity of the external ear andabnormal smallness of that half of the face.

Psychologist is a member of aninterdisciplinary team including: Physicians, general surgeons, plastic surgeons,

dentists, oral surgeons, nurse, social worker,insurance representative, orthodontists


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Craniofacial Clinic

Psychologist conducts a briefassessment of every patient

Issues assessed:

Medical issues

Social functioning

Development

Academic, psychological, and behavioralfunctioning


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Recent Developments in

Pediatric PsychologyAPA 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
http://apa.org/divisions/div54/http://apa.org/divisions/div54/


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Current trends

Managed Care and Reimbursement Has negatively affected delivery of

services

Many peds psych services are notcovered by insurance:

Pain management

Interventions to increaseadherence

Work on multidisciplinary teams


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Response to Managed Care

Medical Cost Offset Research

The cost of pediatric psychology

services would be offset by savingsin medical expedenditures (Roberts,

Mitchell, & McNeal, 2003, p. 14)

This research is somewhat controversial


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Major Developments

Place of Employment

Primary Care

Pediatric psychologists are moving

away from university-based hospitals

Focusing more on primary careintervention and prevention activities

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