Transcript Pediatric and Clinical Child Psychology

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 1900sdevelopments 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 DSMIV-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
Negative behaviors
Toileting
Developmental delays
School
Sleeping
Personality
Sibling/peers
Divorce, separation, adoption
Infant management
Family problems
Sex-related
Food-eating
Specific fears
Specific bad habits
examples
Tantrum, crying
Enuresis
Speech, overactivity
Reading, dislikes school
Nightmares, resist bed time
Poor self-control, stealing
No friends, fighting
Visiting schedule, custody
Feeding, colic
Discipline, child abuse
Poor identification, no same-sex
friend
Picky eater, obesity
Dogs, trucks
Thumb-sucking, tics
Major Activities
General 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 Issues
Epidemiology- 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 Retardation
Learning Disorders
Motor Skills Disorder
Communication Disorders
Pervasive Developmental D/o
Attention-Deficit and Disruptive
Behavior Disorders
Feeding and Eating disorders of
infancy or Early Childhood
Tic disorders
Elimination disorders
Other Disorders of infancy,
childhood, or Adolescence
Mild, Moderate, or Severe Mental
Retardation
Reading D/o, Mathematics D/o
Developmental Coordination D/o
Expressive Language Disorder
ADHD, 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 Activities
General 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. (WISCIV)- (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 checklistParents, 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 metaanalyses 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 Model
Indirect Consultation Model
Collaborative 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