Child Oriented Specialties in Professional Psychology: A

Brief Overview

James H. Johnson, Ph.D., ABPPUniversity of Florida

Child Oriented Specialties in Professional Psychology: What are

They?

•Clinical Child Psychology

•Pediatric Psychology•School Psychology

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.

Clinical Child Psychology: Overview

• A major focus of the specialty is on understanding, preventing, diagnosing and treating psychological, 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.

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;

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;

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;

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.

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

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.

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.

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.

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.

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,

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.

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.

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

Clinical Child Links

• Society of Clinical Child and Adolescent Psychology

• American Board of Clinical Child and Adolescent Psychology

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.

What Do Pediatric Psychologists Do?

•Clinical Work 48% •Teaching 18% •Research 18% •Administration 15%

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%

Academic Home for Pediatric Psychologists

•Medical School Pediatrics 36%

•Medical School Psychiatry 30%

•University Department-Psych. 23%

•Medical School, other 5% •University, other 5%

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%

Top 5 Sources of Work Satisfaction

•Professional Autonomy •Patient Care •Relations with Colleagues •Relationships with Pediatricians •Teaching and Research

Top 5 Sources of Dissatisfaction

•Lack of time for research •Salary •Patient care workload •Financial support for research •Secretarial support

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

Research Activities

• Assessment • infant screening; medical adherence;

depression • Intervention • stress management; enuresis; feeding

disorders • Prevention • injury prevention; nutritional choices;

exercise • Explicative • family adjustment to chronic illness;

sibling effects

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.

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.

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.

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 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?

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

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

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.

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)

Pre Cochlear Implant Evaluations

For a Overview of Cochlear Implantation, Click Below:

Pediatric Psychology Links

•Click on the Link Below for the Society of Pediatric Psychology Website

•National Conference of Child Health Psychology.

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.

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