Child Oriented Specialties in
Professional Psychology: A Brief
Overview
James H. Johnson, Ph.D., ABPP
University of Florida
Child Oriented Specialties in Professional
Psychology: What are They?
• Clinical Child Psychology
• Pediatric Psychology
• School Psychology
Clinical Child Psychology: Overview
• Briefly, Clinical Child Psychology is a
specialty that represents a merging of
basic psychological principles with the
core features of both clinical and
developmental psychology.
• Members of this specialty conduct
research and provide psychological
services for children, adolescents and
families, with there being a dynamic
interplay of research and practice.
Clinical Child Psychology: Overview
• A major focus of the specialty is on
understanding, preventing, diagnosing
and treating psychological, cognitive,
emotional, developmental, behavioral,
and family problems of children.
• A primary defining feature is the
emphasis on understanding children
from the perspective of both normal
development and of psychopathology.
Problems Addressed
• Clinical child psychologists engage in research
and provide clinical services for infants, children
and adolescents displaying a range of problems
including, but not limited to:
– physical and/or psychosocial challenges resulting from
pre-term birth, serious physical illness, prenatal
substance abuse/addiction;
– severe developmental problems such as pervasive
developmental disorders, autism, retardation;
– mental and emotional disorders such as schizophrenia,
attention deficit/hyperactivity disorder, conduct
disorder, anxiety, depression;
– social problems such as delinquency, substance
abuse/dependency, inappropriate sexual conduct;
Problems Addressed (Cont.)
• Other representative problems include:
– coping difficulties associated with stressors
such as parental divorce, remarriage, step
parenting, natural disaster or trauma;
– developmental milestone concerns and difficult
temperament characteristics along with such
problems as toilet training, tantrums, feeding
and sleeping difficulties;
– cognitive deficits or dysfunction in
communication or academic performance;
– psychological aspects of physical illnesses;
Procedures and Techniques
• Among the assessment, intervention, and
consultation procedures and techniques
utilized by clinical child psychologists are:
– interviews, behavioral observations, agenormed psychological tests, personality and
family assessment measures;
– behavioral and cognitive-behavioral
approaches, play therapy, individual
psychotherapy, family therapy and counseling;
– parent education and training;
Procedures and Techniques (Cont.)
• Other procedures and techniques include:
– collaboration with pediatricians to monitor
effectiveness of psychoactive medication, deal
with medication compliance, or help with issues
such as pain management;
– prevention programs aimed at prevention of
problems and disorders such as social deviance
and delinquency;
– health promotion programs and prevention of
abuse and other problems of childhood;
– interdisciplinary consultation.
Work Settings
• Clinical Child Psychologists work in a
variety of work settings, including:
– Academic Departments
– Mental Health Clinics
– Health Sciences Centers (e.g., Psychiatry
Inpatient Units or Outpatient Clinics
– Health Maintenance Organizations
(HMO’s)
– Private Practice
Clinical Child Psychology:
Preparation
• What do I need to do to become a
Clinical Child Psychologist?
• Complete requirements for the doctoral
degree in an accredited psychology
program that provides training in this
area.
– Ph.D. or
– Psy.D.
• Obtain additional specialized training in
Clinical Child Psychology at varying
levels.
Training in Clinical Child Psychology
• In line with APA Accreditation
Guidelines, students in clinical child
psychology programs are expected to
have a thorough background in core
areas that provides both a scientific and
professional foundation for practice.
• This is supplemented by and integrated
with “specialty-specific training”
designed to train students for those
activities central to the specialty.
Training in Clinical Child Psychology
• Training in Clinical Child Psychology
involves didactic training in general
“core” areas of Psychology:
– biological, cognitive, affective, and
social aspects of behavior
– history and systems,
– psychological measurement, and
– research methodology and data
analysis.
Training in Clinical Child Psychology
• Also included would be clinical training in the areas
of:
– human development,
– individual differences,
– psychopathology,
– psychological assessment and diagnosis,
– psychological interventions (including training in
empirically supported treatments and treatment
evaluation), and
– professional standards and ethics.
• Issues of consultation and supervision would also
likely be included, as would issues of cultural and
individual diversity.
Training in Clinical Child Psychology
• Examples of “specialty-specific” training in
Clinical Child Psychology, would include the
following:
• 1) lifespan developmental psychology,
• 2) lifespan developmental psychopathology,
• 3) child, adolescent, and family assessment,
• 4) intervention strategies,
• 5) professional, ethical and legal issues
pertaining to children, youth, and families,
Training in Clinical Child Psychology
• 6) research methods and approaches to
system evaluation,
• 7) issues of diversity specific to Clinical Child
Psychology,
• 8) prevention and health promotion,
• 9) the role of multiple disciplines and service
delivery systems,
• 10) social issues affecting children, youth and
families and
• 11) specialized clinical practicum experiences
in assessment, intervention, and consultation.
Training in Clinical Child Psychology
• In addition to graduate level coursework
necessary to meet doctoral requirements
the following professional activities are
relevant to becoming a specialist in
Clinical Child Psychology:
– Completing a Clinical Child Internship (a
requirement for the doctorate),
– Post-doctoral training in Clinical Child
Psychology.
– Specialty Board Certification in Clinical Child
and Adolescent Psychology.
Examples of Clinical Child Psychology Activities
• A Case of Balloon Phobia
• Being a Scientist-Practitioner in
the Clinic: ADHD – NOT!
• Comorbidity and Mimicry and
ADHD
Clinical Child Links
• Society of Clinical Child and Adolescent
Psychology
• American Board of Clinical Child and
Adolescent Psychology
Pediatric Psychology
• Pediatric Psychology is a field closely to
Clinical Child Psychology.
• It is also closely associated with Health
Psychology.
• It is concerned with physical health and
illness of children and the relationship
between psychological/behavioral
factors and health, illness, and disease.
What Do Pediatric Psychologists Do?
• Clinical Work 48%
• Teaching 18%
• Research 18%
• Administration 15%
Where Do Pediatric Psychologists Work?
• Pediatric Hospital 29%
• General Hospital 20%
• Specialty Hospital-Psychiatry 15%
• Outpatient Clinic 10%
• Private Practice 10%
• Academic Department 10%
• Other 4%
Academic Home for Pediatric Psychologists
• Medical School Pediatrics 36%
• Medical School Psychiatry 30%
• University Department-Psych.
23%
• Medical School, other 5%
• University, other 5%
What Are Workload Expectations?
•
•
•
•
•
•
•
•
Pediatric Inpatients 13%
Pediatric Outpatients 26%
Other Outpatients 9%
Other Inpatients 4%
Teaching 30%
Administration 24%
Research 23%
Percentage of salary covered 84%
Top 5 Sources of Work Satisfaction
• Professional Autonomy
• Patient Care
• Relations with Colleagues
• Relationships with Pediatricians
• Teaching and Research
Top 5 Sources of Dissatisfaction
• Lack of time for research
• Salary
• Patient care workload
• Financial support for research
• Secretarial support
Clinical Activities
• Pediatric Liaison
• Screening for developmental
problems
• Adjustment to chronic illness
• Pain management
• Parent education
• Child abuse and neglect team
• Hospital (medical procedure)
preparation
Research Activities
• Assessment
• infant screening; medical adherence;
depression
• Intervention
• stress management; enuresis; feeding
disorders
• Prevention
• injury prevention; nutritional choices;
exercise
• Explicative
• family adjustment to chronic illness; sibling
effects
Training Needs for Pediatric Psychologists
• Training in Pediatric Psychology is similar to
Clinical Child training in most respects.
• Indeed, the skills that are developed within
the context of Clinical Child training are
likely essential to functioning as an effective
Pediatric Psychologist.
• The well trained Pediatric Psychologist,
however, will need additional training to
function effectively in a health care delivery
system.
Training Needs (Continued)
• Specifically, it will be necessary for the
Pediatric Psychologist to have training in
the following areas:
• Knowledge of the nature of various types of
pediatric medical disorders.
• Training in pathophysiology
• Training in Consultation/Liaison activities
• Knowledge of pediatric health-delivery
systems.
Examples of Pediatric Psychology
Clinical Activities
• Much of the work of the Pediatric
Psychologist is with hospitalized inpatients
- this can involve assessment/consultation
and/or short term intervention.
• Below are three examples of general
Pediatric Psychology Consultations.
– 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.
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
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.
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.
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.
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
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 the child displays.
• Psychologists are often called in to assess for the
possible role of contributing psychological factors.
• The fact that psychological factors are found
to exist does not necessarily mean that they
are causally related to an existing medical
symptoms
• Remember the issue about correlations and
causation?
Things to Look For
• Do psychologically relevant factors (e. g., 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
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 child may often benefit from therapy.
• Parents of these children may also need help in
coping with these types of conditions in their
children
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.
• Candidates involve assessments to look at both
medical and psychosocial issues that contribute to
the overall decision making process.
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
• Appropriateness of expectations
• Challenges to compliance: Past history predicts
future behavior.
• Appropriate Back up support
• Stress and Coping and Support
• Example of Issues;
– : 3 Year Old (bone marrow)
– 17 Year Old (Kidney)
Pre Cochlear Implant Evaluations
For a Overview of Cochlear
Implantation, Click Below:
Pediatric Psychology Links
• Click on the Link Below for the
Society of Pediatric Psychology
Website
• National Conference of Child Health
Psychology.
School Psychology
• School psychologists work in elementary and
secondary schools or school district offices to
resolve students’ learning and behavior problems.
• They collaborate with teachers, parents, and school
personnel to
– improve classroom management strategies or parenting
skills
– counter substance abuse,
– work with students with disabilities or gifted and talented
students, and
– improve teaching and learning strategies.
• They may evaluate the effectiveness of academic
programs, behavior management procedures, and
other services provided in the school setting.
School Psychology Links
• National Association of School
Psychologists (NASP)
• American Psychological Association:
Division of School Psychology
• School Psychology Information
(Power Point Presentation)
• School Psychology Power Point