Clinical Practice in Pediatric Psychology

The purpose of this article is to (a) define e-health interventions, modes of delivery, and comprehensiveness; (b) describe advantages of e-health interventions; (c) provide examples of e-health data collection and interventions; (d) review the research on e-health interventions; (e) describe barriers, and legal and ethical issues relevant to e-health interventions; and (f) provide recommendations for future research and clinical practice.

This study described the development, feasibility, and preliminary effectiveness of an adherence promotion intervention delivered by pediatric health care providers and facilitated by pediatric psychologists to children and adolescents ages 5–14 years with asthma and their caregivers (N = 6). Individual time-series analyses indicated that the intervention was associated with enhanced adherence to daily inhaled corticosteroids. Moreover, the intervention (e.g., feedback to children and parents concerning treatment adherence based on electronic monitoring and problem solving concerning barriers to adherence promotion) was shown to be feasible for delivery in routine follow-up care for asthma and acceptable to families. Findings of this pilot study demonstrated the effectiveness of provider-based adherence promotion to promote adherence to treatment in pediatric asthma. Future research should replicate these findings with larger samples of children with asthma and focus on enhancing the sustainability of treatment adherence over time. Collaborative adherence promotion interventions developed by pediatric psychologists and pediatric subspecialists have the potential to advance clinical practice.

Single-subject research designs and relevant statistical methods have been neglected in the field of pediatric psychology, specifically in research investigating changes in clinical outcomes over time. This commentary provides a brief, nontechnical description and illustration of the use of time series analyses in pediatric psychology research. This commentary focuses on Auto-Regressive Integrated Moving Average (ARIMA), which is a type of time series analysis that models changes in clinical outcomes over time. A brief overview of single subject research designs and alternative time series analyses is described. Although time series analysis has been used infrequently in the field of pediatric research, this analytic approach could be applicable for investigating changes in clinical outcomes over time.

An integrated approach to healthcare brings together professionals from various disciplines and establishes comprehensive treatment plans that address the biological, psychological, and social needs of a patient. Youth with inflammatory bowel disease (IBD) are at risk of psychosocial difficulties and often need psychosocial support near the time of diagnosis in addition to traditional medical support. The need for a biopsychosocial approach to healthcare that emphasizes health promotion among youth with IBD is thus quite great. The purpose of this article is to describe the New Patient IBD Clinic, a clinic that applies a biopsychosocial model of care to the treatment of youth newly diagnosed with IBD. Psychosocial data obtained from 108 youth ages 8–18, as part of standard clinical care during their visit to the IBD clinic, are described and discussed in the context of a patient’s overall functioning, adjustment, and quality of life. Implications for clinical care and treatment planning and recommendations for developing an integrated care model are also discussed.

Early intervention services aim to meet the needs of young children with developmental delays, disabilities, or who are at-risk for developing delays. Children born preterm are at an increased risk for experiencing developmental difficulties, and 60%–70% of premature infants qualify for early intervention services. The purpose of this study was to explore patterns of service utilization and identify barriers to services among a sample of families with children who were followed by a high-risk infant clinic. Results indicated that the overwhelming majority of children had been referred for or were receiving early intervention services, patterns of services received varied across ages, and physical and occupational therapy were most often received. Few direct barriers to accessing services were identified; however, 12% of children were no longer receiving services for reasons other than lack of need or attainment of milestones. The implications for how psychologists can work across the family, medical, and educational systems to improve knowledge and adherence to services will be discussed.

Children with epilepsy are at an increased risk for psychopathology, especially disruptive behavior disorders (DBD). Rates of DBD are especially high in children with frontal seizure foci who undergo frontal lobe surgery. Despite evidence that family and parenting factors have been shown to predict psychopathology in childhood epilepsy, there have been no studies of parenting interventions targeting disruptive behavior in these children. In the present case report, we adapted a validated parent management training intervention, the Brief Behavioral Intervention (BBI), to treat DBD in a 7-year-old boy who had undergone frontotemporal resection for medically intractable epilepsy. The family participated in 12 BBI sessions over a period of 19 weeks. Both parent and teacher report indicated reduction of significant disruptive behaviors to the normal range, with treatment gains generally maintained 2 months following treatment. The present case report demonstrates that parent management training in general, and BBI specifically, can be effective for treating problem behaviors in children with severe neurologically based behavioral presentations.

Although food selectivity is a common problem among children and youth who have autism, research has infrequently evaluated school-based feeding intervention. In this study an 18-year old girl with autism was taught to eat greater variety and quantity of previously rejected foods through a combination of antecedent intervention and positive reinforcement procedures that a teacher implemented during lunch meals. The study describes application of a changing criterion design to measure the effects of gradually increasing feeding expectations through food variation and portion control. We discuss the advantages of antecedent intervention for treating food selectivity in a school setting.

Adolescents with chronic kidney disease often engage in nonadherent behaviors and have poorer outcomes. Dialectical behavior therapy (DBT) promotes quality-of-life improvement, with specific focus on “treatment-interfering behaviors” such as nonadherence. DBT has demonstrated effectiveness with patients who are otherwise difficult to reach, treat, and manage in outpatient settings. This study describes a DBT adaptation for improving adherence in adolescent patients with end-stage renal disease (ESRD). Seven adolescents with ESRD were enrolled in a 9-session DBT program. Process (illness acceptance) and outcome (quality of life, depression) measures were conducted pre- and posttreatment. Transplant team reports of adherence and health improvements were conducted at pre-, mid-, and posttreatment. Significant improvements were evident at posttreatment for depression and adherence. Findings suggest that DBT may promote adherence in difficult-to-treat youth with chronic illness.

The passage of the Affordable Care Act has expanded the role of primary care providers in promoting child and adolescent socio-emotional health and well-being. With additional emphasis on prevention and expanded coverage for services such as developmental screenings, behavioral assessments, and obesity-related services, primary care practitioners will become increasingly involved in child mental health. This expansion provides additional opportunities for psychologists to be involved in service delivery in primary care settings. Many benefits have been noted for involving psychologists in primary care environments such as improved health outcomes and reduced costs. This commentary will explore implications of the Affordable Care Act for medical and psychology providers, along with how psychologists can become involved in implementing patient-centered medical homes, providing mental health services in primary care, with additional recommendations for policy and program changes to enhance integrated health care for children and adolescents.