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