Psychosomatics 46:580-581, December 2005
doi: 10.1176/appi.psy.46.6.580
© 2005 Academy of Psychosomatic Medicine
Handbook of Pediatric Psychology
Edited by Michael C. Roberts, New York, Guilford Press, 2003, 772 pages, $90.00, ISBN 1-57230-906-7
Craig Stuck, M.D.
The recent publication of the Textbook of Psychosomatic Medicine adds to a growing number of texts for psychiatrists working with medically ill adults. But the situation for those providing consultation to medically ill children is far different. With no definitive text or journal for the practice of pediatric psychosomatic medicine, information must be assimilated from numerous journals and the occasional chapter delegated to this specialty. The third edition of the Handbook of Pediatric Psychology is a remarkable exception. This book is a valuable resource for the consultant, providing psychosocial insights and identifying researched interventions relevant to pediatric patients and their families. The range of topics covered is extensive.
For those who trained at institutions without integrated pediatric psychology services, the opening chapters provide an overview of the development of the field. Unlike child psychologists, pediatric psychologists deal with medically related issues in children. The development of the field clarifies the source of their strong liaison with the American Academy of Pediatrics. There is much to learn from the paradigms for coordinating treatment with primary care that is applicable to the psychiatrist providing consultation services for ill children.
Two models of coping with chronic illness help to highlight the challenge of organizing the complicated interactions between an ill child and the child’s environment. One emphasizes risk and resilience factors, and another is organized developmentally. Although neither is complete, they can contribute to our formulations of children adjusting to illness and ultimately to our interventions.
Specific chronic medical conditions headline the chapters comprising the bulk of the book. I have used these to prepare seminars for residents and have found them instructive. The general format is a brief introduction to the illness, then a discussion of the impact on the child and family, adherence issues, and long-term outcome. The chapter titled "Neonatology, Prematurity, NICU, and Developmental Issues" is brilliant. In 13 pages, the information necessary to meaningfully incorporate issues of prematurity in the biopsychosocial model is provided. The interaction between birth weight, prematurity, size for gestational age, asphyxia, and infection is clarified, and many prognostic factors are identified. Most chronic illnesses, with the exception of epilepsy, are included. The principal value of this text is the concise presentation it provides of research-based findings on psychological aspects of specific children’s diseases and problems.
One problem is that most chapters are long on descriptive factors and short on treatment interventions. The editor himself takes issue with the lack of intervention research in the field of pediatric psychology, noting that the number of intervention/therapy reports has decreased in recent years to only 5.4% of the articles published in the Journal of Pediatric Psychology. Despite these shortcomings, a number of the chapters are practical. For example, "Feeding Problems" provides detailed suggestions for the observation of feeder-child interactions during mealtime. A breakdown of behavioral management techniques and many examples of treatments for specific problems, such as food refusal, round out the section. In "Sleep Disorders," those who have been puzzled by the recommendation that a child’s bedtime be shifted forward for the treatment of delayed sleep phase will find the intervention explained. Other practical interventions relate to pain associated with pediatric procedures. How many of us as interns have narrated the intravenous procedure with such phrases as "I’m sorry you have to have this done," "It will be OK," or "Next I’m going to..."? Giving reassurance during procedures, apologizing, and giving explanations have all been shown to promote child distress, whereas humor, distraction, and deep breathing improve child coping. Many other chapters reference articles and books for specific treatments.
Some of the strengths and weaknesses of the handbook reflect the strengths and weakness in the field of pediatric psychology. For example, chapters that address prevention, health promotion efforts, and adherence are excellent, giving evidence-based approaches. The chapter on psychopharmacology was written by school psychologists, and the lack of expertise is only too evident. On the other hand, a chapter addressing school systems and the chronically ill child has a wealth of insight.
A few omissions are perplexing. There is no mention of spirituality as a factor in children’s coping throughout the handbook, except for a mention of religion in the "Social Ecology" chapter, where faith has been relegated to the exosystem and is not addressed in the child’s microsystem. This is a serious oversight. Many of the children we have seen who adjust to their illnesses, despite many risk factors, credit their spiritual beliefs as a principal source of coping.
A chapter on anticipatory grief and bereavement, which had been included in the second edition, has been omitted from this third edition. Bereavement is only briefly addressed under "Pediatric Oncology." Another topic, conspicuous by its absence in a handbook dealing with illness and psychology, is psychosomatic illness.
Overall, the strengths of this text greatly outweigh the limitations. As a supplement to other resources, it would be useful for child psychiatry faculty and residents providing consultation services to medically ill children. It also would be valuable for those interested in research in pediatric psychiatric consultation because it reviews relevant psychological literature and highlights needed areas of study.
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FOOTNOTES
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Dr. Stuck is an assistant professor of psychiatry and the residency training director for child psychiatry at the University of South Carolina in Columbia.
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