Handbook of Pediatric Psychology, Third Edition

I chose to review a textbook on pediatric psychology in order to appreciate a different approach to my own field of child and adolescent psychiatry. This thorough volume does that and more! Its emphasis on the concept of close collaboration between psychology and medicine, albeit with pediatrics, was introduced early, and the primary emphasis was on the collaboration of the psychologist with the medical team, where the psychiatrist is generally involved in consult liaison. Summaries of most chapters are helpful for a quick review. Ethical questions are introduced often and biophysical research agendas are included. In Part I the editor also explores a wide variety of issues beyond the strictly clinical, including training issues, the importance of research, and ethics. Beginning with the history of the field of pediatric psychology, the emphasis on evidence-based practice laid a foundation for what is perhaps the strongest feature of the book - the discussion in nearly every chapter of areas for further investigation. This makes it an excellent source for ideas for the thoughtful researcher. The chapter on training issues would be of equal interest to those involved in the education of psychiatrists, with its emphasis on promoting multidisciplinary experiences. The chapter on ethical issues is particularly strong, practical and relevant. Part II covers the areas of practice that cut across diagnoses, such as health promotion, disease prevention, promotion of coping skills, adherence, and chronic pain. These are all of tremendous importance and would be of interest to any physician. Beginning with health promotion, the determinants of health-related behaviour and interventions to affect them are discussed. A review of programs aimed at children, their environments and public policy emphasizes that psychology informs these programs; but, perhaps more importantly, demonstrates that not all prevention is effective and that evaluation is much needed to promote efficacy. Chapters review the literature on promoting coping and adaptation in youth and their families with acute and chronic medical illness, and the stress that results from treatment. The chapter on adherence includes material on the difficulties of measurement, its determinants and evidence regarding increasing it. A literature review of adjustment in children with chronic diseases demonstrates the lack of consistent data concerning this major issue. A chapter emphasizes that larger entities, such as the medical system and school, play in the adjustment of or lack of it to a child who is ill. I was particularly interested in the lack of training of doctors in dealing with “difficult” patients. Quality of peer relationships is highly co-related with both school success and future social adjustment; an excellent chapter looks at the factors which support these relationships. Pain management and the rationale for its importance indicate another reason for psychologists and psychiatrists to be involved with the medical team. A section on psychopharmacology is included and the various medications employed are reviewed. The sections on medication are out of date, which may be due to its being published in 2003. For example, the section on depression lacks information about efficacy and suicidality, the cardiac risks of Imipramine are not mentioned, and the use of atypical antipsychotics in treating tics or disruptive behaviour disorders are not mentioned. This is not a problem for child psychiatrists who are reading it, but is a weakness for psychologists and other non-physicians who would benefit from practical information about the medications their clients are taking. This subject may have been better dealt with by referring the reader elsewhere. The text next deals with difficulties associated with an impressive series of specific conditions. Separate chapters discuss neonatal illness and prematurity, asthma, cystic fibrosis, diabetes mellitus, sickle cell disease, hemophilia, cancer, HIV/AIDS, traumatic brain injury, spinal cord injury, muscular dystrophy, juvenile rheumatoid arthritis, cardiovascular disease, burns, and gastrointestinal illness. These are areas that are less directly a part of the day-today practice of child psychiatrists who are not involved in consultation liaison, but who nevertheless may treat children with these illnesses. Outlined are the benefits to the psychiatrist of informing his practice of the medical aspects of these disorders and the impact they have on the patient and their family. Another section deals with failure to thrive, feeding problems, pervasive developmental disorders, mental retardation, childhood obesity, enuresis, tics, bruxism, trichotillomania, and sleep problems. An excellent chapter on behaviour problems discusses the clinical interview, the use of scales and techniques that have proved to be effective with children and their parents. The chapter on ADHD reviews its etiology and epidemiology, but then provides only the briefest reference to treatment. The estimates of persistence in adulthood are also low and the impressive body of research on this subject is mentioned only briefly in passing. The book is completed by chapters on child maltreatment, sexual behaviours, and problems of adolescents including programs promoting safe sex. Racial and ethnic health disparities, problems of accessing care, health related quality of life in pediatric populations, pediatric psychology and public health, the importance of evaluating effectiveness as well as efficacy, genetic disorders and testing, tele-health and international pediatric psychology are all reviewed. Despite its overall strengths, a few drawbacks should be mentioned. By necessity, chapters were limited in length. As is the case with all compendiums, there is some unevenness and overlap. Canadian readers will find that the sections on ethics and inequities in health care are excellent, but are taken from the point of view of practitioners in the United States. Less than 10% of the references were from articles published within five years of this book’s printing, making them somewhat out of date. In particular, the general medical overviews, though helpful, suffered as a result. Some terms were named incorrectly (Down syndrome, FAS not FAE). Finally, the chapter on ADHD was disappointing and a major flaw, given the importance of this topic. Nevertheless, this handbook is an excellent resource and a comprehensive but engaging read.

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