Pediatric specialty still rare



Pediatric psychology is a narrow subspecialty of child psychology, according to clinical psychologist Courtney Hale, Ph.D., a faculty member at the University of New England in Portland, Maine. (photo by Michael Eric Berube, Goodphotos.com)

By Phyllis Hanlon

Sigmund Freud and other early psychologists suggested that many psychological problems begin in childhood and intensify as an individual ages. Recently released studies concur with these beliefs and emphasize the importance of addressing mental health issues early in life.

Although the terms child and pediatric in reference to psychology are sometimes used interchangeably, clinical psychologist Courtney Hale, Ph.D., faculty member in the psychology department at the University of New England (UNE) in Portland, Maine, notes a distinct difference between the two. "Pediatric psychology is a subspecialty focused on the relationship between children's physical well being and mental health development," she says. "This is a very narrow specialty within the field and the majority of clinical psychologists who work with kids and families are not technically pediatric psychologists."

Many psychologists who treat children have acquired their expertise through hands-on experience, workshops and seminars. The American Psychological Association's (APA) Division 54, the Society of Pediatric Psychology, expresses in its mission statement a dedication "… to research and practice addressing the relationship between children's physical, cognitive, social and emotional functioning…."

Psychologists who treat children receive referrals from a number of sources - parents, schools, pediatricians, government agencies - for a variety of reasons from behavioral, academic, social, interpersonal and eating issues to depression, attention disorders and alcohol or substance abuse. Benjamin D. Garber, Ph.D., clinical child psychologist, speaker and author from Merrimack, N.H., specializes in attention and conduct disorders, divorce and anger management issues. While his focus is on the youngster, he advocates for parental involvement to achieve harmony within the family. He refers to what he calls "chameleon" kids, those who compromise their identity to fit into the household, particularly when domestic issues or marital difficulties are present. "This can happen whether you're four or fourteen. It carries a risk of drug and/or alcohol abuse, unhealthy relationships and legal issues as the child gets older," says Garber.

In his experience, treating the entire family helps reduce the possibility that parents will undermine the child's therapy.

Often overlooked, the gifted child - a youngster whose IQ equals or surpasses 130 - can present with unique issues, according to clinical child psychologist Deirdre V. Lovecky, Ph.D., director of the Gifted Resource Center of New England in Providence, R.I. She cites asynchrony as one of the most common problems, meaning the gifted child's mental age usually exceeds his chronological age and differs from his social, emotional and, sometimes, his physical age. Trying to manage all those variables becomes a challenge. "These children experience the world intensely. Their depth of emotional experience is deeper," she says.

Lovecky adds, "Being gifted can lead to misdiagnosis." Behavioral issues might be attributed to ADHD, while the child might simply be bored. On the other hand, giftedness might overshadow underlying issues such as depression, Asperger's syndrome or other behavioral disorders. Careful assessment with a standardized battery of tests as well as several one-on-one sessions enables the psychologist to become familiar with the child and make an accurate diagnosis.

Mark Anagnostopulos, Ph.D., psychology service chief at the Brattleboro Retreat in Vt., says that safety is a concern when children become depressed, suicidal, overly impulsive or act out in a violent manner and hospitalization may be necessary. At the Retreat, therapists work "to stabilize a crisis, accurately assess the problem and get them [children] to a place where they can move on to the next level of care," he says. "There is a lot of constant one-on-one teaching, redirection, instruction and negotiation happening with these kids." Anagnostopulos emphasizes the importance of a thoroughly integrated interdisciplinary team to ensure the most effective and efficient therapy for the child. In addition, he views family and social service involvement, as well as adequate inpatient length of stay, critical to stabilize the child and devise a reasonable care plan.

For those interested in specializing in child psychology, formal training is scarce. In her role as educator at UNE, Hale teaches undergraduate programs relating to children and stress as well as general psychology courses into which she incorporates child-related issues.

She says that graduate programs vary considerably from one school to another. "The programs that do the best job have a specific track in child and adolescent psychology," says Hale. She adds that those institutions recruit and retain faculty with compatible backgrounds as well. The first child psychologist at UNE, Hale's search and hire was motivated by student interest in the field.

Anagnostopulos emphasizes the importance of continuously updated education, supervision and mentoring in graduate school as well as attendance at appropriate workshops. "Most licensing authorities do have provisions that you practice within your realm of expertise as determined by your education and clinical experience. Sometimes it's not defined any more closely than that," he says. "It's more of an ethical matter for psychologists to adhere to that."

For 35 years, Robert A. Ciottone, Ph.D., has been teaching child assessment courses at Clark University in Worcester, Mass. Some of his students provided reasons for joining this growing field. Karen Wachs, a third year graduate student, had volunteered at a domestic violence clinic where she worked with male perpetrators, couples and their children. "I developed an interest in helping these people and learning more about the conditions that set up their behavior," she says.

Fourth year student Valerie Haskell previously taught in the New York city public school system and saw firsthand the need for studying the social and emotional development of children. "I am interested in how people negotiate their way in the world," she says. "I'm interested in doing my part in that (area)."

Christine Sauck, also a fourth year student, switched from pre-dental to psychology after viewing a film about play therapy. "The therapists were teaching a mother how to play with her child who didn't want to be touched," she says. "I want to find ways to help mothers or parents and children work together."

Hale surmises that clinical study will drive future assessment methods and intervention. "In the field of psychology, research is increasing and advancing its understanding of the development and resilience of kids," she says. "The lens through which we see and conceptualize issues is based on updated research."

Pediatric specialty still rare (August/September 2005 Issue)

Pediatric specialty still rare
(August/September 2005 Issue)