Clinical Practice in Pediatric Psychology

Staff in pediatric and neonatal intensive care units (PICU and NICU) experience high rates of burnout due to the highly stressful environment. There is growing literature describing stress and burnout, but to date, no review of the evidence specific to pediatric and neonatal intensive care. For the development of interventions to reduce and prevent burnout, there needs to be a better understanding of this evidence. Little is known about coping strategies employed by critical care staff; it is important to collate and critique this literature to inform interventions. The objective of this systematic review was to examine burnout occurrence and coping strategies among staff working in PICU and NICU.

A systematic search of Web of Science (WoS), Scopus, Medline, AMED, PsycINFO, CINAHL, Nice Evidence, and EMBASE was conducted following PRISMA guidelines.

Studies measuring burnout and/or coping in PICU and NICU were included in the review. Twenty-two studies met the inclusion criteria, the majority of which used a quantitative cross-sectional design. Of the included studies, 14 measured burnout, and 17 measured coping.

Staff working in pediatric and neonatal intensive care settings experience high rates of burnout. While staff may have the ability to use coping strategies, often time and lack of awareness mean they don't. Psychologically informed interventions are required to prevent burnout and to provide staff with the tools and resources to develop healthy coping strategies in order to boost their well-being. Those interventions must then be formally evaluated to determine their impact on staff psychological outcomes.

This work offers insight into avenues for future research to further describe the nature of burnout and to identify the predictors of successful coping. The literature review shows that there is variation in the way burnout and compassion fatigue are measured; working toward a consensus for a “gold standard” measurement would help synthesize the evidence. Coping is less well described and measures are not always appropriate; further work is required to identify and measure the impact of coping strategies to develop the evidence base.

Postural orthostatic tachycardia syndrome (POTS) is a type of autonomic dysfunction that limits engagement in functional behaviors and negatively impacts mood and quality of life (QoL). Nonpharmacological strategies such as lifestyle modification are recommended as part of treatment; however, there is little research or theory regarding other nonpharmacological therapies used in treatment. Given the paucity of literature examining other nonpharmacological therapies for POTS, current evidence for their application to POTS was reviewed.

A topical review was conducted to identify research studies that used nonpharmacological interventions to treat individuals with POTS.

Of the 370 identified studies, 25 met inclusion criteria. Sixteen of the 25 studies examined lifestyle modifications for POTS and were not described in the review, given that lifestyle modifications are already well accepted and recommended in nonpharmacological treatment of POTS. The remaining studies were grouped into three categories: Tactile Interventions, Mind–Body Interventions, and Interdisciplinary Treatment Programs. Findings suggest a variety of nonpharmacological interventions have the potential of benefiting patients with POTS; however, the scarcity of studies and methodological concerns limit the interpretability of this research.

An agenda for future research and implications for psychologists are provided. With the help of psychologists to advance applied research in effective nonpharmacological strategies for treatment, patients with POTS will have access to additional treatment options that address their biopsychosocial needs and hopefully positively impact QoL.

In addition to currently recommended lifestyle modifications, other nonpharmacological strategies may have the potential to benefit patients with postural orthostatic tachycardia syndrome (POTS). While the literature on these nonpharmacological interventions is limited, providers can build on initial findings to create treatment protocols or coordinate multicenter studies to examine different nonpharmacological interventions and provide additional options for patients with POTS to receive holistic care.

The purpose of the study was to implement a comprehensive adverse childhood experiences (ACEs) screening protocol in a rural Integrated Primary Care Clinic serving Latino Children utilizing implementation science as a framework.

The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was utilized to guide and evaluate the implementation. There were 2,347 children who were screened with the developed protocol which included screening for ACEs, psychosocial problems, adolescent depression, and parental depression. Several implementation outcomes were collected and are reported, including a list of screening barriers and adaptations, a list of developed staff training, a clinician stakeholder survey and focus group, and a patient stakeholder survey.

Clinicians reported being satisfied with the protocol and indicated that screenings provided new clinical information, changed their clinical care and helped to inform the medical needs of patients. Barriers included inadequate time to complete screenings and over-screening for prevalent stressors in the community.

Implementation science provides a reliable framework for the implementation of a comprehensive ACE screening process by identifying the necessary conditions for high-quality implementation. With the appropriate resources in place, screenings are possible and enhance patient care. More attention is needed to identify primary care interventions for ACEs.

Implementation science provides models for implementation that can improve the uptake of ACE screenings in Pediatric Primary Care settings. Integrated Care presents a comprehensive interdisciplinary approach that aids in providing appropriate responses to positive screenings.

The extant pediatric biofeedback literature has several shortcomings, including small sample sizes, inconsistent methodology, and variable means to determine outcomes. The purpose of the current study was to build upon the existing literature and examine the feasibility of a brief, semi-structured, biofeedback intervention with a larger outpatient pediatric sample.

Via chart review, we explored 2 years of referrals (N = 79) to our biofeedback program. We examined feasibility in terms of recruitment, program completion, and patient/caregiver satisfaction. Secondary aims included examination of changes in physiological and self-report data.

Seventy-three percent of referrals to the biofeedback program attended a first session, with 67% of those that attended a first session completing the program. The majority of patients who completed the program (N = 39, M_age = 13.4 years, 69% female) were referred for anxiety as their presenting problem. Both patients and parents were found to be highly satisfied with the program. By the end of treatment, almost all youth were able to demonstrate a lower respiration rate, accompanied by both improvements in heart rate variability (HRV) indices and self-reported somatic symptoms. The majority of patients, however, did not achieve the goal of a respiration rate lower than 8.0 breaths per minute.

The current study demonstrated that a brief, semi-structured biofeedback protocol was feasible in terms of recruitment, retention, and satisfaction with an outpatient pediatric sample. Moreover, youth who completed the program demonstrated improvements as evidenced by physiological and self-report indices.

This work holds important implications for pediatric psychology care, including that a brief psychology trainee-delivered, semi-structured biofeedback program was found to be feasible and acceptable to patients and families delivered in an outpatient setting. The program was found to be acceptable by participants with diverse diagnoses (e.g., anxiety and pain-related disorders). The current study contributes to the pediatric biofeedback literature by providing further direction around both implementation and outcome measurement in pediatric biofeedback.

Text messaging is a promising weight loss intervention modality for emerging adults who are overweight, but few studies exist to guide intervention development. Furthermore, sleep is emerging as a salient intervention target for weight management. This study examines feasibility and acceptability of two text messaging interventions for weight control in emerging adults, one of which includes sleep intervention content.

Forty-three emerging adults who were overweight (BMI ≥ 25 < 30; ages 18–21) were randomized to receive either a text messaging intervention focused on diet and physical activity change, or a text messaging intervention designed to modify sleep behavior plus diet and physical activity. The interventions included motivational interviewing, education around health behaviors, physical activity, and dietary goal setting, as well as sleep goals for those in the sleep condition. All participants self-monitored diet, physical activity, and weight via text message for 3 months; those in the sleep intervention monitored nightly sleep duration.

Intervention acceptability and engagement were high for both conditions. In exploratory analyses, we observed that body mass index remained stable across assessments, regardless of condition. Participants in the sleep modification condition showed significantly greater sleep duration from pre- to post-intervention than those in the standard intervention.

This study demonstrates that a weight loss intervention delivered by text messaging, including components designed to improve sleep, is acceptable and feasible for emerging adults who are overweight, and that extended sleep duration may be a benefit of the sleep modification intervention.

This study provides support for the feasibility and acceptability of a text messaging intervention combining traditional behavioral weight loss strategies with sleep intervention in emerging adults. Results also suggest that a weight loss intervention targeting sleep improvements may increase sleep duration.

Recruitment for Psychology Clinical Internship is a complex and labor-intensive process. The objective of this study is to describe a data-driven procedure to maximize objectivity and optimize outcome for internship recruitment.

The Psychology Training Committee designed an objective rating system for online applications and interviews, incorporating both objective and subjective data. Perceptions of efficiency and effectiveness with this approach were assessed via a survey distributed to the approximately 50 faculty members who have participated in the internship recruitment process. Intern perceptions following completion of the program were also assessed.

This recruitment procedure is highly efficient, as the streamlined process of reviewing applications, developing a list of candidates to interview, and generating final rankings of candidates interviewed occurs quickly, with limited burden to training faculty. The system has demonstrated effectiveness, as there have been no unfilled internship slots and all matched applicants have been within the top half of the rank list generated annually. All interns during this period of time have successfully completed the program, and data suggest that the training interns have received has met (or exceeded) their expectations. Survey data from training faculty echo these findings.

This data-driven approach to internship recruitment has been easy to implement. This approach provides a highly effective and flexible system for ranking a diverse and qualified group of applicants and has the potential to be utilized by other training programs within psychology, as well as across a wide range of disciplines within the medical field.

This study describes a data-driven procedure developed to maximize objectivity and optimize outcome for internship recruitment. The approach reviewed has demonstrated efficiency and effectiveness for recruiting a diverse and qualified group of applicants. It has the potential to be utilized by other training programs within psychology and medicine more generally.

Youth with inflammatory bowel disease (IBD) may be at increased risk for sleep difficulties due to the painful and inflammatory nature of their disease. Moreover, children and adolescents with IBD experience impairment across a variety of psychosocial domains. However, researchers have yet to investigate the complex interplay between sleep, disease-related symptoms, and psychosocial factors in this population. The purpose of this study was to examine sleep patterns, pain, and mood in pediatric IBD.

A sample of 25 children and adolescents with IBD (M_age = 14.24, range = 10–18 years; 56% male) were recruited from a pediatric gastroenterology clinic. Youth wore an actigraphy watch and completed daily measures of affect and pain over the course of 14 days. Statistical analyses involved repeated measures general estimating equations.

No significant association for sleep with negative affect was demonstrated. Despite majority of this sample being in disease remission, results revealed that increased sleep onset latency was associated with presence of next day pain and pain was associated with better next night sleep efficiency.

Findings of the current study suggest youth with IBD experience poor sleep quality, which is significantly related to the pain they experience. Consequently, healthcare providers should screen for and address sleep quality to optimize outcomes in their pediatric patients. Objectively assessing sleep patterns (e.g., actigraphy) may prove useful for pediatric IBD samples; however, additional research is needed to determine actigraphy’s feasibility and efficacy in assessing sleep patterns in real world settings (e.g., pediatric medical clinics).

There is increasing awareness of the prevalence of poor sleep quality among children and adolescents with inflammatory bowel disease (IBD). This study suggests that such sleep difficulties are related to abdominal pain and may be present even for youth whose disease is in remission. It is essential to regularly screen for poor sleep quality and target these concerns in the pediatric IBD population.

Understand the perspectives of children who survived acute lymphoblastic leukemia (ALL) and their parents to adapt a guideline-based, family-based, intensive health behavior and lifestyle intervention treatment for this population.

Nine children 8–17 years of age (Mdn = 12 years [interquartile range, 10–16], median years off treatment = 5 [2–7]) who survived ALL and 11 parents participated in focus groups to assess perceptions of weight, weight-related behaviors, and perceived barriers to family-based behavioral weight loss treatment (FBT). Responses were analyzed thematically, and resultant adaptations were guided by the Framework for Reporting Adaptations and Modifications-Enhanced.

Topics and themes identified included mental and physical health concerns (e.g., treatment-related medical complications, body esteem), a perception of excess weight as protective, the continuing influence of eating habits established during cancer treatment (e.g., instrumental feeding practices, snacking), and potential barriers to activity (i.e., physical limitations, lack of sport experience). Resultant adaptations to FBT were contextual (e.g., virtual delivery) and related to the content, including an emphasis on weight management in the context of survivorship; education about late effects, overweight and obesity; increased emphasis on structured eating patterns and instrumental eating; provider recommended physical activity; and tailored emotion-focused and body esteem content.

Focus groups for children who survived pediatric ALL provided insights that aided the adaptation of FBT for this population. A pilot trial of FBT for children who survived ALL and their parents is underway to evaluate acceptability, feasibility, and preliminary efficacy.

This study elicited perspectives of children who survived acute lymphoblastic leukemia and their parents to inform the adaptation of an intensive health behavior and lifestyle treatment for this population. The adaptation, which is delivered entirely virtually and includes an increased emphasis on emotion-focused content and structured and instrumental eating patterns, may offer a promising approach to decrease the risk for chronic, treatment-related medical complications within this population.

This article aims to explore ethical tensions in pediatric gender-affirming care and illustrate how these tensions arise in the clinical setting.

This article utilizes two de-identified cases of transgender youth—Emma and Jayden—as a framework for discussing ethical principles in pediatric gender-affirming care. Case summaries detail the medical history of these two patients, their familial context, and their encounters with healthcare providers. Subsequently, the ethics of both cases are synthesized. As represented in this work, these cases do not constitute Institutional Review Board-regulated human subjects research.

Emma’s parents want to forgo pubertal suppression and pursue hormone therapy, effectively skipping a step in the gender-affirming care standard for youth presenting in early puberty. Jayden’s parents, on the other hand, are skeptical of their son’s identity and resistant to pursuing treatment. Both cases reflect disparate health goals between youth and parents and offer insight into the ethical tensions of gender-affirming care for pediatric patients.

Key ethical discussions center on the standard of care, treatment reversibility, and pediatric decision-making. Jayden’s parents resist the standard of care for pediatric transgender patients. In contrast, Emma’s parents seek an acceleration of the staged progression recommended in the standard-of-care guidelines. The degree of reversibility of the treatment option in question influences the deliberation of these cases because it is the provider’s ethical obligation to preserve the future rights and autonomy of pediatric patients. Finally, while capacity in children is not presumed, providers should actively involve pediatric patients in treatment decisions that are increasingly subjective.

The standard of care, treatment reversibility, and pediatric decision-making are three important considerations in the ethical provision of gender-affirming care for pediatric patients. Clinicians and decision-makers, including parents, ought to weigh the impact of each consideration on patient autonomy. Although the autonomy of pediatric patients is necessarily limited, steps should be taken to safeguard these patients’ future decision-making capacity and align with their healthcare goals and values to the fullest extent possible.