Child Oriented Specialties in Professional Psychology: A Brief Overview

1. Child Oriented Specialties in Professional Psychology: A Brief Overview James H. Johnson, Ph.D., ABPP University of Florida

2. Child Oriented Specialties in Professional Psychology: What are They? • Clinical Child Psychology • Pediatric Psychology • School Psychology

3. Clinical Child Psychology: Overview • Briefly, Clinical Child Psychology is a specialty that represents a merging of basic psychological principles with the core features of both clinical and developmental psychology. • Members of this specialty conduct research and provide psychological services for children, adolescents and families, with there being a dynamic interplay of research and practice.

4. Clinical Child Psychology: Overview • A major focus of the specialty is on understanding, preventing, diagnosing and treatingpsychological, cognitive, emotional, developmental, behavioral, and family problems of children. • A primary defining feature is the emphasis on understanding children from the perspective of both normal development and of psychopathology.

5. Problems Addressed • Clinical child psychologists engage in research and provide clinical services for infants, children and adolescents displaying a range of problems including, but not limited to: • physical and/or psychosocial challenges resulting from pre-term birth, serious physical illness, prenatal substance abuse/addiction; • severe developmental problems such as pervasive developmental disorders, autism, retardation; • mental and emotional disorders such as schizophrenia, attention deficit/hyperactivity disorder, conduct disorder, anxiety, depression; • social problems such as delinquency, substance abuse/dependency, inappropriate sexual conduct;

6. Problems Addressed (Cont.) • Other representative problems include: • coping difficulties associated with stressors such as parental divorce, remarriage, step parenting, natural disaster or trauma; • developmental milestone concerns and difficult temperament characteristics along with such problems as toilet training, tantrums, feeding and sleeping difficulties; • cognitive deficits or dysfunction in communication or academic performance; • psychological aspects of physical illnesses;

7. Procedures and Techniques • Among the assessment, intervention, and consultation procedures and techniques utilized by clinical child psychologists are: • interviews, behavioral observations, age-normed psychological tests, personality and family assessment measures; • behavioral and cognitive-behavioral approaches, play therapy, individual psychotherapy, family therapy and counseling; • parent education and training;

8. Procedures and Techniques (Cont.) • Other procedures and techniques include: • collaboration with pediatricians to monitor effectiveness of psychoactive medication, deal with medication compliance, or help with issues such as pain management; • prevention programs aimed at prevention of problems and disorders such as social deviance and delinquency; • health promotion programs and prevention of abuse and other problems of childhood; • interdisciplinary consultation.

9. Work Settings • Clinical Child Psychologists work in a variety of work settings, including: • Academic Departments • Mental Health Clinics • Health Sciences Centers (e.g., Psychiatry Inpatient Units or Outpatient Clinics • Health Maintenance Organizations (HMO’s) • Private Practice

10. Clinical Child Psychology: Preparation • What do I need to do to become a Clinical Child Psychologist? • Complete requirements for the doctoral degree in an accredited psychology program that provides training in this area. • Ph.D. or • Psy.D.   • Obtain additional specialized training in Clinical Child Psychology at varying levels.

11. Training in Clinical Child Psychology • In line with APA Accreditation Guidelines, students in clinical child psychology programs are expected to have a thorough background in core areas that provides both a scientific and professional foundation for practice. • This is supplemented by and integrated with “specialty-specific training” designed to train students for those activities central to the specialty.

12. Training in Clinical Child Psychology • Training in Clinical Child Psychology involves didactic training in general “core” areas of Psychology: • biological, cognitive, affective, and social aspects of behavior • history and systems, • psychological measurement, and • research methodology and data analysis.

13. Training in Clinical Child Psychology • Also included would be clinical training in the areas of: • human development, • individual differences, • psychopathology, • psychological assessment and diagnosis, • psychological interventions (including training in empirically supported treatments and treatment evaluation), and • professional standards and ethics. • Issues of consultation and supervision would also likely be included, as would issues of cultural and individual diversity.

14. Training in Clinical Child Psychology • Examples of “specialty-specific” training in Clinical Child Psychology, would include the following: • 1) lifespan developmental psychology, • 2) lifespan developmental psychopathology, • 3) child, adolescent, and family assessment, • 4) intervention strategies, • 5) professional, ethical and legal issues pertaining to children, youth, and families,

15. Training in Clinical Child Psychology • 6) research methods and approaches to system evaluation, • 7) issues of diversity specific to Clinical Child Psychology, • 8) prevention and health promotion, • 9) the role of multiple disciplines and service delivery systems, • 10) social issues affecting children, youth and families and • 11) specialized clinical practicum experiences in assessment, intervention, and consultation.

16. Training in Clinical Child Psychology • In addition to graduate level coursework necessary to meet doctoral requirements the following professional activities are relevant to becoming a specialist in Clinical Child Psychology: • Completing a Clinical Child Internship (a requirement for the doctorate), • Post-doctoral training in Clinical Child Psychology. • Specialty Board Certification in Clinical Child and Adolescent Psychology.

17. Examples of Clinical Child Psychology Activities • A Case of Balloon Phobia • Being a Scientist-Practitioner in the Clinic: ADHD – NOT! • Comorbidity and Mimicry and ADHD

18. Clinical Child Links • Society of Clinical Child and Adolescent Psychology • American Board of Clinical Child and Adolescent Psychology

19. Pediatric Psychology • Pediatric Psychology is a field closely to Clinical Child Psychology. • It is also closely associated with Health Psychology. • It is concerned with physical health and illness of children and the relationship between psychological/behavioral factors and health, illness, and disease.

20. What Do Pediatric Psychologists Do? • Clinical Work 48% • Teaching 18% • Research 18% • Administration 15%

21. Where Do Pediatric Psychologists Work? • Pediatric Hospital 29% • General Hospital 20% • Specialty Hospital-Psychiatry 15% • Outpatient Clinic 10% • Private Practice 10% • Academic Department 10% • Other 4%

22. Academic Home for Pediatric Psychologists • Medical School Pediatrics 36% • Medical School Psychiatry 30% • University Department-Psych. 23% • Medical School, other 5% • University, other 5%

23. What Are Workload Expectations? • Pediatric Inpatients 13% • Pediatric Outpatients 26% • Other Outpatients 9% • Other Inpatients 4% • Teaching 30% • Administration 24% • Research 23% • Percentage of salary covered 84%

24. Top 5 Sources of Work Satisfaction • Professional Autonomy • Patient Care • Relations with Colleagues • Relationships with Pediatricians • Teaching and Research

25. Top 5 Sources of Dissatisfaction • Lack of time for research • Salary • Patient care workload • Financial support for research • Secretarial support

26. Clinical Activities • Pediatric Liaison • Screening for developmental problems • Adjustment to chronic illness • Pain management • Parent education • Child abuse and neglect team • Hospital (medical procedure) preparation

27. Research Activities • Assessment • infant screening; medical adherence; depression • Intervention • stress management; enuresis; feeding disorders • Prevention • injury prevention; nutritional choices; exercise • Explicative • family adjustmentto chronic illness; sibling effects

28. Training Needs for Pediatric Psychologists • Training in Pediatric Psychology is similar to Clinical Child training in most respects. • Indeed, the skills that are developed within the context of Clinical Child training are likely essential to functioning as an effective Pediatric Psychologist. • The well trained Pediatric Psychologist, however, will need additional training to function effectively in a health care delivery system.

29. Training Needs (Continued) • Specifically, it will be necessary for the Pediatric Psychologist to have training in the following areas: • Knowledge of the nature of various types of pediatric medical disorders. • Training in pathophysiology • Training in Consultation/Liaison activities • Knowledge of pediatric health-delivery systems.

30. Examples of Pediatric Psychology Clinical Activities • Much of the work of the Pediatric Psychologist is with hospitalized inpatients - this can involve assessment/consultation and/or short term intervention. • Below are three examples of general Pediatric Psychology Consultations. • 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.

31. 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

32. 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.

33. 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.

34. 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.

35. 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

36. 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 the child displays. • Psychologists are often called in to assess for the possible role of contributing psychological factors. • The fact that psychological factors are found to exist does not necessarily mean that they are causally related to an existing medical symptoms • Remember the issue about correlations and causation?

37. Things to Look For • Do psychologically relevant factors (e. g., 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

38. 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 child may often benefit from therapy. • Parents of these children may also need help in coping with these types of conditions in their children

39. 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. • Candidates involve assessments to look at both medical and psychosocial issues that contribute to the overall decision making process.

40. 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 • Appropriateness of expectations • Challenges to compliance: Past history predicts future behavior. • Appropriate Back up support • Stress and Coping and Support • Example of Issues; • : 3 Year Old (bone marrow) • 17 Year Old (Kidney)

41. Pre Cochlear Implant Evaluations For a Overview of Cochlear Implantation, Click Below:

42. Pediatric Psychology Links • Click on the Link Below for the Society of Pediatric Psychology Website • National Conference of Child Health Psychology.

43. School Psychology • School psychologists work in elementary and secondary schools or school district offices to resolve students’ learning and behavior problems. • They collaborate with teachers, parents, and school personnel to • improve classroom management strategies or parenting skills • counter substance abuse, • work with students with disabilities or gifted and talented students, and • improve teaching and learning strategies. • They may evaluate the effectiveness of academic programs, behavior management procedures, and other services provided in the school setting.

44. School Psychology Links • National Association of School Psychologists (NASP) • American Psychological Association: Division of School Psychology • School Psychology Information (Power Point Presentation) • School Psychology Power Point