Pediatric and Clinical Child Psychology

Definitions, History, and Perspectives

clinical child psychology

A branch of psychology that deals with assessing and treating children and adolescents following the development of psychopathological symptoms. Often, this work is conducted in private settings or in outpatient clinic settings. Clinical child psychologist are often more diverse in their theoretical orientations than pediatric psychologist, and they tend to place a greater emphasis on training in assessment, developmental process, and family therapy.

History of clinical child psychology

• 1896-Witmer stimulated the profession of clinical psychology, devoted to children having learning problems or disruptiveness in classroom.

• 1800, and early 1900s- developments occurred to increase the focus on children(Ollendick & Hersen, 1998) the identification and care of those with mental retardation, the development of intelligent testing, the formulation of psychoanalysis, and behaviorism, the child study movement, and the emergence of child guidance clinics.

DSM-I, DSM-II regarded childhood problems as downward extensions of adult disorders. DSM-II and continuing today with DSM-IV-TR, we now have diagnostic categories specifically relevant to children(APA, 2000).

The field is essentially oriented toward assessment, treatment, and prevention of a variety of problems.

pediatric psychology(child health psychology)

A branch of psychology that deals with treating children and adolescents prior to or early in the development of psychopathology. Pediatric psychology referrals often come from pediatricians, and the work is frequently performed in medical settings. Compared to clinical child psychology, pediatric psychologist tend to use short-term, immediate intervention strategies and tend to place a greater emphasis on medical and biological issues in their approaches.

History of pediatric psychology

Evolved as a specialty when it became apparent that neither pediatrics nor clinical child psychology could handle all the problems presented in childhood(Roberts, 1986).

Many “ well-child” visits to pediatricians require support and counseling rather than medical interventions.

Wright (1967), recognized the “marriage” between pediatricians and psychology, called for a new specialty-pediatric psychology.

Pediatric Psychology was formed, in 1999 became an official division of the American Psychological Association.

A developmental perspective

Psychological problems in children and adolescents results from some deviation in one or more areas of development (cognitive, biological, physical, emotional, behavioral, or social) when compared with same age peer (Mash & Wolfe, 2002).

a.Development is an active, dynamic process that is best assessed over time.

b. similar developmental problems may lead to different outcomes (clinical disorders).

c.Different developmental problems may lead to the same outcome.

d. Developmental processes and failures may interact.e. Developmental processes and the environment are

interdependent- each influences the other such that they cannot be viewed separately (I.e. in isolation) (Mash & Wolfe, 2002).

Cont. Developmental Perspective

The age of children, stage of development across spheres of functioning (cognitive, emotional, social) and their family and social situations must be considered as one tries to conceptualize their problems and prescribe treatment. These developmental considerations help the pediatric or clinical child psychologist decide whether a problems is indeed present, how severe it is, how to conceptualize it, and what kind of intervention to recommend.

Resilience

The term Resilience refers to qualities in individuals that are associated with their ability to over come adversity and achieve good development outcomes (Masten & Coatsworth, 1998).

Capacity to function effectively in situations where others might develop maladaptive behavior. The to recover quickly from an illness, change, misfortune.

Studies of resilience and competence can lead to interventions aimed at preventing or eliminating risk factors, building or improving resources, and enhancing relationships or processes such as a self-efficacy and self-regulation (Masten & Coatsworth, 1998).

Examples of Problems Commonly Addressed by Pediatric Psychologist

problems examples

Negative behaviorsToiletingDevelopmental delays SchoolSleepingPersonalitySibling/peersDivorce, separation, adoptionInfant managementFamily problemsSex-relatedFood-eatingSpecific fearsSpecific bad habits

Tantrum, cryingEnuresisSpeech, overactivityReading, dislikes schoolNightmares, resist bed timePoor self-control, stealingNo friends, fightingVisiting schedule, custodyFeeding, colicDiscipline, child abusePoor identification, no same-sex

friendPicky eater, obesityDogs, trucksThumb-sucking, tics

Major ActivitiesGeneral Issues

There are many diverse and still evolving activities in which pediatric and clinical child psychologist are involved.

Activities involve: Assessment, Intervention, Prevention, and consultation.

General IssuesEpidemiology- It is important to have some idea of how comment

various problems are across age groups and other segments of the population. Epidimiology data can help us address these issues. To properly understand and diagnose, the filed must have information on how behaviors change over time, how they covary with one another, and how behaviors are distributed throughout the community.

The Situation_ behavior is often situation specific. To adequately conceptualized a Childs problems, attention should be paid to the interaction between factors in the child’s environment and generalized personality characteristics.

DSM-IV-TR Disorders Usually First Diagnose in Infancy, Childhood, or Adolescence

Group Diagnostic Examples

Mental RetardationLearning DisordersMotor Skills DisorderCommunication DisordersPervasive Developmental D/oAttention-Deficit and Disruptive

Behavior DisordersFeeding and Eating disorders of

infancy or Early ChildhoodTic disordersElimination disordersOther Disorders of infancy,

childhood, or Adolescence

Mild, Moderate, or Severe Mental Retardation

Reading D/o, Mathematics D/oDevelopmental Coordination D/oExpressive Language DisorderADHD, Conduct Disorder

Pica, Rumination Disorder

Tourette’s Disorder, Transient Tic D/o

Encopresis, ENURESIS

Separation Anxiety D/o, Selective Mutism

Assessment

When assessing children and adolescents, it is almost always necessary to seek information from other people besides the child: parents, teachers, social workers, school psychologist, physician, and other others. It is important to obtain the child’s permission to seek information from other sources.

Children and adolescents know less about the roles of mental health professional and thus may harbor resistance or even fear. It is very important to estimate the nature and severity of the problem early. The examiner will want to learn why help is being sought, how long the problem has existed, and what other steps have been taken to resolve the problem. a case Hx.. will then be generated to gain and understanding of exactly how the problem has developed. All this is done to determine the nature of the problem and how best to deal with it.

Major ActivitiesGeneral Issues

Diagnosis and Classification of Problems-the classification of childhood disorders has been of more interest to clinical child specialist than to pediatric psychologist because the former have historically had to deal more often with psychiatric cases. DSM-IV-TR incorporates the growing interest in childhood disorders.

Psychological problems experienced by children and adolescents are subdivided:

Internalizing disorders are characterized by symptoms of anxiety, depression, shyness, and social withdrawn (e.g. separation anxiety disorder).

Externalizing disorders are characterized by aggressive behaviors, impulsive behaviors, and conduct problems (e.g. conduct disorder).

Cont.Assessment

Interviewing- it is important to find how the child feels and what the child understands as the real purpose for the visit. The clinician must set a reassuring tone for the interview and then, within the limits of the child;s understanding, explain what will take place.

Behavioral Observations- direct observations of the child at home and school should be undertaken if possible. There are naturalistic, analog, participant, and self-observational techniques for use with children, and a variety of coding systems for rating behavior. Commonly used : Direct Observation Form (DOF) of the Child Behavior Checklist.

Intelligence Test-when questions of intellectual achievement, academic deficit, or the development of an educational plan for the child are involved, intelligence test are used. (WISC-IV)- (K-ABC),(WPPSI-R) ARE SOME EXAMPLES OF TEST.

Cont. Assessment

Achievement Test- used to assessed past learning.

Projective Test-the use of projective test is controversial because of the general lack of good reliability and validity data.

Questionnaires and checklist-Parents, teachers and others

who are in frequent contact with the child can provide information at general or very specific levels and in terms of personality characteristics.

• Neuropsychological Assessment

• Cognitive Assessment• Family Assessment

Interventions

Psychoanalytically Oriented Therapy- the approach is more symptom oriented and is designed to teach the child that certain behaviors are really defenses against anxiety.

Play Therapy-play becomes a substitute for verbalization.Behavior Therapy- systematic desensitization, aversion therapy,

or contingency management techniques, are efficient in comparison to older, more traditional psychodynamic methods.

Behavioral Pediatrics- behavioral rehearsal, stress inoculation to various methods of cognitive reappraisal.

Cognitive Behavioral Therapy- the basic idea is to improve problem solving and enhance planning and delay gratification.

Group and Family Therapy- because of children are so greatly influences by and are the product of their families, in some cases it only makes good sense to treat the entire family.

Are Psychological Interventions for Children and Adolescents Efficacious?

Recent reviews of the treatment outcome literature agree that, in general, psychological interventions for ch8ildren and adolescents are efficacious (e.g. Kazdin, 2003; Peterson & Bell-Dolan, 1995; Weisz, Donenberg, Han, & Weiss, 19950. This conclusion is based on the converging results of several major meta-analyses of the treatment outcome literature. Further, recent reviews have identified specific interventions for specific child and adolescent problems that have empirical support.

Pharmacological Treatment

Medications are used by themselves or as adjuncts to psychotherapy in the treatment of children and youth.

The most frequently used medications are those that treat deficit/hyperactivity disorder. Examples: psychostiumulant methylphenidate (Ritalin)>Traditional tricyclic antidepressant medication has not been shown consistency efficacious in the treatment of childhood depression. among the anxiety disorder the , medications have been shown efficacious in the treatment of of childhood obsessive-compulsive disorder.

Prevention

• The principle, that, in the long run, preventive activities will be more efficient and effective than individual treatment administered after the onset of the disease or problem. both pediatric and clinic child psychologist focus on the prevention of childhood problems (e.g. by providing education, establishing safety programs, and identifying and proactively treating children at risk).

Consultation

Consultations-liaison relationship have long been typical in the professional lives of pediatric psychologist.

Consultations occur with parents, pediatricians, medical staff, school system, welfare agencies, juvenile court system, and other health or service agencies. It may involve request for immediate and very brief help or long-term interventions.

Models of Consultation: Independent Functions ModelIndirect Consultation ModelCollaborative Team Model

Training

• Life Span Developmental psychology• Life span developmental psychopathology• Child, Adolescent, and family assessment methods• Interventions Strategies• Research Methods and systems evaluation• Professional, ethical, and legal issues• Issues of diversity• Multiple disciplines and service delivery systems• Prevention, family support, and health promotion• Social issues affecting children, adolescents, and families• Specialized experience in assessment, intervention and

consultation