User:Enlowpat/sandbox

Pediatric psychology is a multidisciplinary field which attempts to apply psychological methods in a pediatric health setting. The main focus of the field is to promote the health and normal development of children and their families through empirically based treatments.

Common areas of study include psychosocial development, environmental factors which contribute to the development of a disorder, outcomes of children with medical conditions, treating the comorbid behavioral and emotional components of illness and injury, and promoting proper health behaviors.

= History =

Mind/body Problem
The mind/body problem, simply put, examines how the mind and body interact.? Are they separate from each other or do they interact? Over the course of history, there have been many views as to how the two entities operated. In order to better understand the origins and views of pediatric psychology a firm grasp of this philosophical issue is of utmost importance.

The presence of trephination in pre-history cultures suggests that early humans may have viewed the mind and body as interrelated in some fashion. The ancient Greeks were the next group to address the issue of the mind and the body. They attributed illness to an inbalance in the body. According to the four humours theory of illness, the fluids in the body (blood, black bile, yellow bile, and phlegm, were out of balance with each other and therefore caused an illness. From the Greeks, the two major approaches to this problem were proposed: monism and dualism.

Monism
Monism was Aristotle's reaction to Plato's dualism. Aristotle did not believe in the pure forms, ideas that exist in a person’s mind, untainted by the physical world, which had heavily influenced Plato. As a result Aristotle believed that the body and the soul (mind) were the same. Aristotle often described the soul is the same as the person’s physical body. There is no separation between the two.as essentially the individual's nature as a human. While Aristotle did believe that the mind and body were one entity he noted that the intellect was different in that it must be able to identify all forms of an object (e.g., identify that both a soccer ball and basketball basket ball are a form of the object ball). With this idea in hand it becomes apparent that the mind was considered to be in control of the body. For a long time this belief that the body was a puppet and the mind its master was considered to be true. However, with a new era of intellectual fervor dualism would soon become the accepted theory.

Dualism
Dualism originated with Plato and his view on metaphysics. He believed that the intellect (e.g., the mind) was ephemeral and strove to leave the physical body. The main idea behind dualism is that the mind and the body are completely separate entities.

With the dawning of the Renaissance and the great strides in science and philosophy many new scholars addressed this problem, the most prolific being Rene Descartes. While his views were dualistic in nature, he deviated from the normal path by expressing that there was a mutual interaction between the two, and the body had a greater influence on the mind. This declaration would have been seen as extremely radical in Descartes's time.

Biopsychosocial Model & Health Psychology
In the past, most physicians followed the biomedical model which posited that all illness can be explained by improper functioning of the biological systems. By 1977, With the large leaps in medical science forced and changing views of health and illness ddoctors and psychologists to begin, alike, began to questioning their old methods of treating patients. This new method of thought is the biopsychosocial model and it was heavily influenced by two main issues: the specificity problem and the base rate problem.

Specificity Problem
This problem address the fact one environmental stressor is often associated with many different disorders. An example of this would be work stress. Being stressed out at work can lead to hypertension; however, it can also lead to coronary heart disease. It is nearly impossible to tell which path will be taken as a result of the stress, and it could result in both.

Base Rate Problem
This problem states that it is very hard to predict whether the presence of a stressor will lead to the development of a disorder. The reason behind this is that experiencing the environmental stressor may lead to developing the disorder. However, diagnosing a patient on this alone would result in an absurd amount of false positives. An example of this would be smoking and cancer. If doctors were to diagnose everyone who ever smoked a cigarette or a cigar with cancer it would quickly become apparent that it is an ineffective diagnostic criterion because many individuals would not develop lung cancer.

Holistic Method
The main premise of the biopsychosocial model is that you cannot separate the biological factors from the environmental factors when addressing an illness; you must view a person as part of a whole, or a system. The system theory is one of the best methods in which to observe this holistic model. The systems theory states that an individual exists within a hierarchy of subsystems (e.g. cells, person, family, society, etc.), and all of these subsystems interact. For example, if one were to lose a family member the individual may feel stressed which in turn may weaken his immune system and cause him or her to catch a cold. While the cold is considered biological in nature (i.e. a bacterium or a virus), it was aided by outside factors. This is a great example of how the biopsychosocial model approaches medical conditions. In order to effectively assess an illness one must identify and treat all contributing factors as well as the actual biological factors. This need to address physical, mental, and social needs (among many others) lead to health psychology, and from this the field of pediatric psychology.

Origins
World War II gave way to a rise in the amount of psychologists that worked in medical schools. The pediatric population doctors worked with had a variety of problems in addition to their illnessDoctors had children as patients with a variety of problems (e.g., developmental, behavioral, academic). Patients needs, and their families, were not receiving adequate attention from psychology clinics at the time.

To meet the needs of pediatric patients Jerome Kagan requested a “new marriage” between psychology and pediatrics, stressing early detection of psychopathology and psychosocial problems. Understanding prenatal- and perinatal factors relating to psychological problems was also emphasized.

The term “pediatric psychology” was first used in 1967 by Logan Wright in the article “The Pediatric Psychologist: A Role Model,” and was defined as “dealing primarily with children in a medical setting which is nonpsychiatric in nature”. Wright emphasized the importance of:


 * group identity for the pediatric psychology field (formal organization, distributing newsletter)
 * specifications for training future pediatric psychologists
 * body of knowledge accumulated by means of applied research

Organizational developments
Pediatric psychologists established a group identity with the Society of Pediatric Psychology (SPP). SPP was initially an interest group in the Clinical Child Psychology division of the APA. As membership elevated, SPP was recognized by the APA as a group whose purpose was to “exchange information on clinical procedures and research, and to define training standards for the pediatric psychologist”. With this new-found recognition, division 54 of the APA was created. Some of the main goals of this organization are to promote the unique research and clinical contributions from pediatric psychology.

The Journal of Pediatric Psychology was founded in 1976, and it has helped to further the professional recognition of the field. It allowed for clinicians, teachers, and researchers alike to exchange ideas and new discoveries. It is a respected scholarly journal which aims to increase the knowledge regarding children who suffer from acute and chronic illness, and attempt to identify and resolve the contributing factors in order to yield optimal outcomes.

=Modern Training=

Becoming a Pediatric Psychologist
The road to becoming a pediatric psychologist is long and consists of many years of training. Most clinicians have a strong background in psychology coming out of their undergraduate schooling. It is ideal for prospective students to take courses in developmental psychology, health psychology, developmental psychopathology, abnormal psychology, and many others. In order to be competitive when applying to graduate schools, most students will have a strong background in research either as an assistant in a pediatric psychology lab, conducting independent studies, or both. Student's may also find it beneficial to acquire field experience with children in order to demonstrate that they can become adept clinicians. In addition to this, for admission to graduate school, it is necessary to have a relationship with three or more psychologists in order to provide letters of recommendation.

To become a full-fledged pediatric psychologist one must obtain a doctoral degree in the form of either a Ph.D. or Psy.D. in clinical or counseling psychology. Graduate training typically requires 4-5 years of graduate school and an additional year spent on an internship. Some programs will require the completion of a master's thesis while others will not. All, however, will require that students complete a dissertation consisting of original research. A doctoral program will use the scientist practitioner or Boulder model which emphasizes training in both clinical practice and research methodology, while a PsyD program will likely use the Vail model  which emphasizes clinical skills much more than research. Some schools will provide a specialization in child clinical psychology or health psychology which can supplement normal training with a pediatric twist. Another aspect of graduate training is external practicums in settings such hospitals or clinics. Gaining experience working in these areas is essential in order to be prepared to obtain a job after graduate school. In order to help standardize the training each psychologist receives, the Society of Pediatric Psychology task force developed a list of 12 training areas necessary for a specialty in pediatric psychology:


 * 1) Lifespan development
 * 2) Lifespan developmental psychopathology
 * 3) Child, adolescent, and family assessment
 * 4) Intervention strategies
 * 5) Research methods and systems evaluation
 * 6) Professional, ethical, and legal issues pertaining to children, adolescents, and families
 * 7) Diversity issues and multicultural competence
 * 8) Role of multiple disciplines in service delivery systems
 * 9) Prevention, family support, and health promotion
 * 10) Social issues affecting children, adolescents, and families
 * 11) Consultation-liaison (CL) roles
 * 12) Disease process and medical management

After graduate school, there are many choices in order to determine the field best suited to one’s interests. Some individuals will engage in a fellowship which will allow for increased knowledge in specific areas of clinical psychology and research and may yield more job opportunities. A postdoctoral fellowship may also provide supervised clinical hours which are required in order to become independently licensed in a state. Finally, some pediatric psychologists will go on to engage in clinical practice while others will not. In order to practice as a clinical psychologist one must obtain a doctoral degree from an approved program, complete a required amount of supervised clinical hours, pass the Examination for Professional Practice in Psychology (EPPP), and be knowledgeable of all state regulations.

Research in Pediatric Psychology
The main goal of pediatric research is to understand child development occurring with health-related issues. Using ecological systems framework, pediatric psychologists discover the ways in which health issues might affect children and their families and ways to promote physical health and psychological adjustment in pediatric-health populations.

Important issues currently addressed in pediatric psychology research across various diagnoses include :


 * Cultural and diversity issues
 * Evidence-based practice
 * Inpatient pediatric consultation-liaison
 * Adherence to treatment regimens
 * Chronic and recurrent pain
 * Management of pain and distress due to medical procedures
 * Pharmacology and psychopharmacology
 * Medical traumatic stress
 * Palliative care, end of life, bereavement
 * eHealth application
 * Pediatric psycho-oncology

Common research areas in pediatric psychology

 * Neonatology, prematurity, and developmental issues
 * Pediatric asthma
 * Cystic fibrosis
 * Diabetes mellitus
 * Sickle cell disease
 * Pediatric oncology
 * Traumatic brain injury and spinal cord injury
 * Central nervous system disorders (e.g., epilepsy, spina bifida)
 * Juvenile rheumatoid arthritis
 * Cardiovascular disease
 * Pediatric organ transplantation
 * Abdominal pain-related gastrointestinal disorders (e.g., irritable bowel syndrome, inflammatory bowel disease)
 * Pediatric burns
 * Feeding and vomiting problems
 * Pediatric obesity
 * Eating disorders
 * Elimination disorders (e.g., enuresis, encopresis)
 * Pediatric sleep
 * Autism spectrum disorders and developmental disabilities
 * Behavior problems in a pediatric context
 * Attention-Deficit/Hyperactivity Disorder in the pediatric context
 * Child maltreatment