Clinical Child Psychology

Clinical Child Psychology vs. Pediatric Psychology Considerable overlap, but… Clinical Child Psychologists – typically work with children and adolescents once psychological systems have developed –Usually in private practice settings or outpatient clinics –Diverse in orientation –Traditional training (assessment, developmental processes, family therapy)

Pediatric Psychology AKA child health psychology Usually practiced in medical settings Frequently intervene before psychopathology develops More likely to adopt a cognitive-behavioral orientation More short-term interventions Tend to emphasize medical and biological issues in training, research and service delivery

History Remember – Clinical Psychology has its roots in the assessment and treatment of childhood disorders – Witmer, Binet However, through the 20 th century, study of childhood psychopathology was largely ignored – “adultmorphism” Neither Psychoanalysis or Behaviorism recognized the unique nature of childhood disorders

DSM-III The first version of the DSM to make specific recommendations concerning developmental considerations in the diagnostic criteria for childhood disorders

Nowadays DSM-IV: Over 2 dozen Axis I disorders specific to children Several major journals concerned with children: Journal of Abnormal Child Psychology, Journal of Clinical Child Psychology Division 53 – Clinical Child and Adolescent Psychology Division 54 – Pediatric Psychology New field of study: Developmental Psychopathology – the study of childhood disorders from a developmental perspective

Why the recent attention? Psychopathology relatively common in childhood (8 – 22% of children diagnosed with a behavioral, emotional or learning disorder) Many childhood disorders have lifelong consequences Most adult disorders have their roots in childhood disorders By studying childhood disorders, may be better able to develop effective early interventions Media attention to high-profile, child-related problems (school violence, misuse/over-use of meds, child abuse, etc.)

Issues Unique to Clinical Child Psychology 1. Referral Issues 2. Developmental Considerations –Rapid physical, social, cognitive and behavioral changes 3. Infant Temperament (Thomas, Chess, etc.) 4. Early Attachment (Object Relations theory, Bowlby, Ainsworth)

Childhood Stressors Maladaptive parenting Birth of a sibling Exposure to poverty Starting school Parental conflict and divorce Child abuse

Classification Issues Greater emphasis on empirically derived classification Based more on research and use of clinical rating scales

Assessment Issues As with adults, continued concern with psychometric properties of the instruments Many of same techniques used However: –More information supplied by adult referral services –Cognitive maturation limits usefulness of self-report data –Majority of referrals from schools, having to do with school-based problems –Almost always include concerns with behavior within the family setting –Issues of confidentiality

Treatment Talk therapy not really an option for younger children – verbal skills, insight Play therapy Behavior therapy – especially operant procedures Cognitive-Behavioral Interventions Biological Interventions – medication, dietary modifications