Clinical Child Psychology

1. Clinical Child Psychology

2. 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)

3. 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

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

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

6. 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

7. 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.)

8. 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)

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

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

11. 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

12. 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