1. Pediatric Psychology: An Overview
James H. Johnson, PhD, ABPP
University of Florida

2. Overview of Pediatric Psychology
Pediatric Psychology is closely allied with Clinical Child Psychology.
Also with Health Psychology.
Concerned with physical health and illness of children and the relationship between psychological/behavioral factors and health, illness, and disease.
Settings in which Pediatric Psychologists work include Hospitals, Clinics, Pediatric Practices, Developmental Centers, and HMO’s.
They function in various roles – Consultant, diagnostician, therapist, information resource.

3. Examples of Ped Psych Activities
Much of the work of the Pediatric Psychologist is with hospitalized inpatients
This can involve assessment/consultation and/or short term intervention.
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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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

9. 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 you are being consulted about.
The fact that psychological factors are found to exist does not necessarily mean that they are causally related to existing medical symptoms
Remember the issue about correlations and causation?

10. Things to Look For
Do psychologically relevant factors (eg., 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

11. 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 children may often benefit from therapy.
Parents of these children may also need help in coping with these types of conditions in their children

12. 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.
These assessments involve looking at both medical and psychosocial issues that may have to do with the possible outcomes of transplantation.

13. 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
Challenges to compliance: Past history predicts future behavior.
Stress and Coping and Support
Example of Issues;
: 3 Year Old (bone marrow)
17 Year Old (Kidney)

14. Pre Cochlear Implant Evaluations: A Model for Information Gathering