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Child Oriented Specialties in Professional Psychology: A Brief Overview. James H. Johnson, Ph.D., ABPP University of Florida. Child Oriented Specialties in Professional Psychology: What are They?. Clinical Child Psychology Pediatric Psychology School Psychology.

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Child Oriented Specialties in Professional Psychology: A Brief Overview

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Child Oriented Specialties in Professional Psychology: A Brief Overview

James H. Johnson, Ph.D., ABPP

University 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 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.

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 adjustmentto 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

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