Introduction to Pediatric PsychologyWhat is Pediatric Psychology?Roots of Pediatric PsychologyDefining FeaturesClinical Activities: SettingsSlide 6Types of IssuesTypes of IssuesIt Looks Physical, But is it?Somatization DisorderConversion DisorderPsychological Factor Affecting Medical ConditionPsychological Factors Affecting Medical ConditionDiagnostic Criteria for 307.59 Feeding Disorder of Infancy or Early ChildhoodConsiderations in Psychological/Medical LinksPsych Problems Due to Medical ConditionsThings to Look ForCase ExamplesSlide 19Examples of Pediatric Psychologists on UF Clinic TeamsTransplantation EvaluationsIssues to Consider in Pre-Transplant EvaluationPediatric Endocrinology ClinicSlide 24Slide 25Peds Endo ConsultPediatric Endocrinology Consult: Typical IssuesCraniofacial ClinicSlide 29Recent Developments in Pediatric PsychologyCurrent trendsResponse to Managed CareMajor Developments Place of EmploymentIntroduction to Pediatric Introduction to Pediatric PsychologyPsychologyGregg Selke, Ph.D.November 14, 2006PSY 4930What is Pediatric Psychology?What is Pediatric Psychology?Concerned with physical health and illness of children and the relationship between psychological/behavioral factors and health, illness, and disease.“Pediatric Psychology” first coined in 1967 by Logan Wright, “dealing primarily with children in a medical setting which is nonpsychiatric in nature” (p. 323)Roots of Pediatric PsychologyRoots of Pediatric PsychologyC l i n i c a l C h i l d P s y c h o l o g yD e v e l o p m e n t a l C o n s i d e r a t i o n sI m p o r t a n c e o f t h e f a m i l yH e a l t h P s y c h o l o g yI n t e r a c t i o n b e t w e e n h e a l t h a n dp s y c h o l o g i c a l f u n c t i o n i n gP e d i a t r i c P s y c h o l o g yDefining FeaturesDefining Features1. Promotion of healthy behaviors2. Prevention of problematic health effects (e.g., unhealthy lifestyles, behavioral patterns….overeating)Goal: Target behaviors early in life or early in the onset of a chronic medical conditionClinical Activities: SettingsClinical Activities: SettingsInpatient medical units–Consultation/liaison services–Medical units such as hem/onc, burn, PICUMedical outpatient clinics–Private pediatric practices–Clinics such as craniofacial, endocrinologyOutpatient psychology clinicsClinical Activities: SettingsClinical Activities: SettingsSpecialty clinics–Physical rehabilitation centers, Child study centersCamps or groups–Camps for children with chronic illnessTypes of Issues Types of Issues Problems related to pediatric conditions–Adjustment to disease–Adherence–Coping with procedural painMental health problems arising in medical units–Behavior problems while hospitalized (e.g., noncompliance)–Bereavement (Death and Dying issues)–Reintegration into school after hospitalizationTypes of IssuesTypes of IssuesGeneral mental health concernsPrograms for health promotion and early intervention–Programs to increase physical activity–Early intervention with high-risk infantsMental retardation and developmental disabilities–Assess, train, and educate parents and professionalsEducation/consultation for physiciansPublic health and public policyIt Looks Physical, But is it?It Looks Physical, But is it?The pediatric psychologist is often called on by physicians to determine whether psychological factors are contributing to or causing a child problemsDSM-IV diagnostic categories of:–Somatization Disorders –Conversion Disorders–Psychological Factors Affecting Medical Condition–Feeding and Eating Disorders of Infancy or Early ChildhoodPica, Rumination Disorder, Feeding Disorder of Infancy and Early ChildhoodSomatization DisorderSomatization Disorder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 DisorderConversion Disorder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 Psychological Factor Affecting Medical Condition 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 Factors Psychological Factors Affecting Medical ConditionAffecting 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–Example:Depression and diabetesNeedle phobia and diabetesDiagnostic Criteria for 307.59 Feeding Diagnostic Criteria for 307.59 Feeding Disorder of Infancy or Early ChildhoodDisorder of Infancy or Early ChildhoodA. Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least 1 month.B. The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).C. The disturbance is not better accounted for by another mental disorder (e.g., Rumination Disorder) or by lack of available food.D. The onset is before age 6 years.Considerations in Considerations in Psychological/Medical LinksPsychological/Medical Links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