Field Of Pediatric Psychology Research Articles

Introduction to Commentary: Exploiting Opportunities Created by the Patient-Reported Measurement Information System in Pediatric Psychology

Patient recorded outcomes [e.g. health-related quality of life (HRQOL), functional status, etc.] have assumed increasing importance in research and clinical care in the fields of pediatrics and pediatric psychology (Palermo et al., 2007; Varni, Limbers, & Burwinkle, 2007) for several cogent reasons: (a) these measures are sensitive to the issues associated with health status that are most important and salient to children and their families in evaluating outcomes of medical treatment; (b) patient-reported outcomes complement and extend the evaluation of medical treatments beyond the traditional measures of psychological status, biomarkers, and symptoms; (c) data that are generated from patient-reported outcomes can facilitate communications among children, families, and providers, inform shared decision making concerning medical treatment and improve children’s well-being (DeWit et al., 2008). However, widespread clinical application of patient-reported outcomes and generalizability of findings across settings and chronic conditions in the field of pediatric psychology are needed. In their article, Forrest and colleagues describe the application of the Patient-Reported Measurement Information System (PROMIS ) for children and youth and implications for the field of pediatric psychology. This introduction highlights several of the salient issues raised by Forrest et al. (2012) for the field of pediatric psychology.

Training in Pediatric Psychology--Current Perspectives and Future Opportunities: Introduction to the Special Section

The most personally and professionally gratifying of my activities in the field of pediatric psychology has involved training of undergraduate, graduate, and postdoctoral fellows (Drotar, 2003). I continue to be impressed by the intellectual curiosity, values, and compassion, and raw talent that are demonstrated by the remarkable cadre of graduate and fellowship level trainees who are attracted to pediatric psychology. The future of our field will be theirs. To ensure their and our future, we need to be the best possible stewards of the extraordinary promise of these careers in the making by creating the most optimal training opportunities, experiences, and career paths for our future practitioners, teachers, and researchers. This special issue on training in pediatric psychology was conceived to address this continuing need. Training in pediatric psychology has evolved in important ways since the founding of our field (LaGreca, Stone, Drotar, & Maddux, 1988; Roberts et al., 1998; Spirito et al., 2003). The Society of Pediatric Psychology Task Force Report (2003): Recommendations for the Training of Pediatric Psychologists considered issues related to breadth and depth of training, scope of practice, training paths, primary care, interdisciplinary training, and mentors (Spirito et al., 2003). Topic areas identified as most important for obtaining knowledge and expertise in pediatric psychology included life span development, developmental psychology and developmental psychopathology, child, adolescent, and family assessment, intervention strategies, research methods and systems, evaluation, professional ethical and legal issues, diversity, roles of multiple disciplines in service delivery, prevention, family support, and health promotion, social issues affecting children, adolescents, and families, consultant and liaison roles, and disease process and medical management. This report was an important milestone in the development of training in our field as it expanded on the prior survey results and recommendations for pediatric psychology (LaGreca et al., 1988) and clinical child psychology. Since the Task Force report (Spirito et al., 2003), training programs that focus on pediatric psychology or offer pediatric training as part of another program at graduate, internship, and postdoctoral levels have expanded significantly. However, training programs in pediatric psychology face a number of significant challenges: Recruiting graduate students and facilitating development of their core competencies in both specialized training and an increasing breadth of content areas, training students to meet the challenges of research careers, and promoting the development of mentors in our field. The manuscripts in this special section respond to these challenges of pediatric psychology training.

Contemporary Directions in Research Ethics in Pediatric Psychology: Introduction to the Special Section

The importance of research on ethics in the field of pediatric psychology is multifaceted: research on a wide range of pediatric studies raises continuing ethical concerns related to informed consent, including parental permission and assent (Appelbaum, Lidz, & Grisso, 2004; Brody, Scherer, Annett, & Pearson-Bish, 2003; Drotar, 2008; Masty & Fisher, 2008; Miller, Drotar, & Kodish, 2004; Miller & Nelson, 2006; Vitiello, 2008). Moreover, genetic and genetic testing research (Patenaude, 2005), prevention and intervention research with high-risk pediatric populations (Bauman, Sclafane, LoIancono, Wilson, & Macklin, 2008), and comparative effectiveness research that compares two active treatments (Stines & Feeney, 2008; Tunis, Benner, & McClellan, 2009) raise challenging new ethical issues. Research on the ethical conduct of psychological research with children and adolescents is needed for several important reasons: ethical principles such as respect for persons require investigators to facilitate informed consent (parental permission and assent) and appreciate factors that promote parents’ and childrens’ understanding of risks and benefits and informed, engaged research participation. The ethical principle of justice encourages investigators to develop methods to enhance research participation of minority and/or economically disadvantaged research participants who are underrepresented in research in pediatric psychology. To the extent that investigators implement research that facilitates diverse research participants’ informed engagement in research, this will enhance the quality of internal validity as well as the generalizability of data that are obtained. Research on pediatric ethics will also illuminate important areas such as family communication and decision making, which are highly relevant to the management of pediatric chronic illness. Data from studies of ethics in pediatric psychology will also facilitate the training of researchers to enhance the quality of their interactions with research participants and improve the ethical conduct and methodological quality of their research. Finally, data from research on ethics in pediatric psychology can inform the decisions of institutional review boards (IRBs) concerning critical areas of research ethics such as parent and child experiences in research participation, perceptions of risk and benefits, and quality of consent. The extraordinary variation in pediatric IRB practice across settings, which is well documented (Kimberly, Hoehn, Feudtner, Nelson, & Schreiner, 2006), may be highly influenced by local practices, including experience with the types of research conducted in specific settings, and IRB membership composition. Valid and compelling data on important ethical issues provide generalizable scientific knowledge that can inform IRB practice and policy in specific areas of pediatric psychology research. What are the types and functions of research on pediatric ethics? Kon’s (2009) conceptualization of different levels of research on bioethics provides a useful framework. The first category, descriptive or ‘‘lay of the land’’ research, defines current practices, opinions, beliefs, or decision making in a specific area of research or clinical care (Kon, 2009). Research on practices of payment to pediatric research participants (Weise, Smith, Maschake, & Copeland, 2002). In this volume, Birnie, Noll, Chambers, von Baeyer, and Fernandez’s description of researchers’ practices with the cold pressor test is an excellent example of this type of research. A second category, ‘‘ideal’’ versus ‘‘reality’’ research starts with an

Commentary: Increasing Cultural Diversity in Pediatric Psychology Family Assessment Research

The clinical and validation studies published in this issue are very timely, as they continue to refine theoretical models and evidence-based family assessment measures for vulnerable pediatric chronic populations. The studies in this issue individually and collectively advance our understanding of what predicts and informs parental and family outcomes across a number of pediatric chronic illness groups. These findings will also be critical to advancing family-based clinical practice and treatments for children with chronic illnesses (Alderfer et al., 2008; Kazak et al., 2007). In total, the articles increase the potential to include nontraditional families, use multi-method and validated assessment tools, and to integrate family measures with other assessment tools so that we can take a comprehensive approach to assessment in our work as pediatric psychologists. While this special issue of JPP advances our understanding of family assessment and processes related to pediatric conditions, it also reveals the continued need to improve cultural sensitivity in pediatric and family assessment (Alderfer et al., 2008; Shudy et al., 2006). This editorial will discuss the challenges and opportunities for enhancing diversity in pediatric psychology family assessment research, as well as the implications for how culturally sensitive family assessment informs clinical practice and research for culturally diverse populations (Clay, Mordhorst, & Lehn, 2002; Ochieng, 2003; Wood, 2005). Trends in publications confirm that the general pediatric family psychology and family assessment literature has increased over the past 25 years, most notably in the past 10 years when publication rates have more than doubled. Using JPP as the example to illustrate growth in trends over time, there will be more articles published on the topic of ‘‘family’’ in this issue than there were published on the topic of ‘‘family’’ in the year 1980 when there were total eight articles (and these numbers remained below 30 in most of the years in the 1980s). Much of the journal’s space focused nearly exclusively on childfocused articles with a behaviorally focused assessment and/or intervention. In contrast, when using ‘‘family’’ as a keyword in 2009, 118 articles were published in the journal, and in 2010, 77 such articles were published through the third quarter. When the key words were narrowed to ‘‘family assessment,’’ the number of published articles was 105 since 1980 and half of these 52 (50%) were published since 2003, highlighting the emerging trend to better integrate family assessment tools in pediatric research. Finally, when examining the number of articles with a ‘‘family assessment’’ and a ‘‘cultural’’ or ‘‘diversity’’ focus, the number of articles was fewer than five. This rate held true even when looking for articles written on specific racial or ethnic subgroups (e.g., using ‘‘family assessment’’ as a search term with ‘‘African American’’ or ‘‘Hispanic/Latino’’). While JPP offers a great context for making the case for why attention should now be given to diversity issues in the field, trends are likely to be similar in other journals and in the broader literature. With the publication of this issue, it is fitting to celebrate the evolution and progress of family assessment research in the field of pediatric psychology, while also acknowledging the gap that still remains in the family assessment literature with respect to cultural diversity. We have to find sensitive and valid methods and models for applying and translating family assessment concepts and

Commentary: Family Assessment in Pediatric Psychology

The theoretical and research literatures on links between family functioning and pediatric chronic health conditions are extensive both in their comprehensiveness and depth. On the other hand, the assessment of family relationships is no easy task and there appear to be gaps between the quality of our family assessment methods and our theories, research methodologies, and clinical endeavors (Kazak, 2008). Why is the assessment of family functioning so challenging? First, when studying families, the focus of one’s research questions can be on individuals (e.g., the functioning of mothers, fathers, children), dyads (e.g., relations between mothers and children, relations within sibling pairs), the family system (e.g., the level of cohesiveness in the family as a whole), or any combination of these. Second, the same individual may serve different roles within the family (e.g., a mother could also be a spousal partner; an adolescent is a child but could also be a sibling). Third, there are different methods of assessment that can be employed with families (e.g., questionnaires, observational methods, interviews, daily diaries) and these methods often yield nonoverlapping or divergent data. Fourth, with our assessment methods, we are attempting to evaluate the functioning of the families where the individuals themselves as well as their health status are changing over time. Finally, such research is particularly challenging in families with individuals who have chronic health conditions because the assessment of family functioning can be based on generic and/or illness-related family assessment methods. Despite such challenges, empirical studies of families are among the most common types of research in the field of pediatric psychology and have been the basis for entire volumes and special issues of journals. In fact, one of the co-editors of the current special issue authored a review of 29 of the most commonly used family-based measures in pediatric psychology and concluded that the database for 19 of these measures had advanced to the point where they could be classified as “well-established” (Alderfer et al., 2008). Although this is an impressive number of high-quality measures, Alderfer et al. (2008) also advanced several recommendations for those who seek to further the quality of family assessment in the field of pediatric psychology. First, they maintained that many family measures were developed on general populations and that little is known about the psychometric quality of these measures in samples of individuals with chronic health conditions. Second, they suggested that we need more studies that focus on fathers and siblings and that the literature on the effects of factors such as family structure and ethnicity on family functioning in pediatric populations is less well developed. Finally, they suggested that we lack knowledge concerning the clinical utility and treatment sensitivity of our family-based measures (Alderfer et al., 2008). Although one issue of a journal could not possibly address all of the challenges of family assessment or the recommendations of Alderfer et al. (2008), the current special issue moves the field forward by providing new measures (including the development of noncategorical and disease-specific measures of various aspects of family functioning), novel uses of previously developed measures, and new approaches to integrating across existing measures. The contributors are all to be commended for the value of their research in advancing the field of pediatric psychology. In this commentary, we first discuss the many strengths of the articles in this issue. Next, we evaluate the evidence base for the family-based instruments included in these papers by using the checklist for measure development and validation, which we published in the Journal of Pediatric Psychology in 2009 (Holmbeck & Devine, 2009). Finally, we discuss research that is needed to continue our progress in the area of family assessment.

Editorial: A Call for Replications of Research in Pediatric Psychology and Guidance for Authors

Various scientists have underscored the critical need for replication of research findings in the development of science, including behavioral science (Cohen, 1994; Hedges, 1987; Robinson & Levin, 1997; Shaver & Norton, 1980). However, replication of research in behavioral science in general and pediatric psychology in particular has been limited (Kline, 2004, 2009). My review of articles in the Journal of Pediatric Psychology (JPP) for the past several years indicate that replications of research findings in our field are rare. There are several reasons for this: The editorial process for scholarly journals places a high premium on new and innovative research findings rather than replications. Grant review criteria used by the National Institutes of Health (NIH) that emphasize innovative research may also inhibit research replications. Although the reasons are understandable, the relative absence of replication limits the cumulative impact, generalizability, and ultimately the validity of science (Cohen, 1994; Robinson & Levin, 1997). To address the need for more frequent research replications in the field of pediatric psychology, the purpose of this editorial is to describe the importance of research replication, types and exemplars of study replication, issue a call for replication research, and provide guidance for authors in submitting replications to JPP.

Brief Report: Doctoral Training Origins of Authors Publishing in Journal of Pediatric Psychology: Historical Trends 1976–2006

To identify historical trends in the field of pediatric psychology by examining the training origins of authors publishing in Journal of Pediatric Psychology since its formation in 1976. The researchers sampled four publication years (1976, 1986, 1996, and 2006) and recorded the authors of each published article. They obtained each author's doctoral training institution using information provided in the article, the American Psychological Association Membership Directory, or the ProQuest Dissertations and Theses Database and counted authorship totals for each institution in each year. Four institutions (Case Western Reserve University, University of Iowa, University of Kansas, and Purdue University) produced authorship entries in 3 of the 4 years sampled. The number of articles being published, the number of authors per article and the number of institutions consistently increased. The current study provided a historical perspective on graduate training and scholarly productivity in the field of pediatric psychology. Future research should investigate interesting trends revealed, such as how core groups of pediatric psychology scholars have contributed to the notable growth in institutions, specific programs within institutions, and authors published over the last 30 years.

Editorial: Integrating Research and Practice: The Role of the Journal of Pediatric Psychology

The integration of research and practice in the field of pediatric psychology remains an important but elusive goal, despite early precedents (Wright, 1967; Wright, Nunnery, Eichel, & Scott, 1968) and more recent developments in dissemination of empirically supported interventions (Spirito & Kazak, 2006) and evidence-based assessments (Cohen et al., 2008). Despite these developments, published research in pediatric psychology still does not emphasize intervention, clinical significance, or dissemination of valid interventions (Brown, 2007; Drotar, 2002; Kazak, 2000; LaGreca, 1997; Roberts, 1992). Moreover, published research on psychological interventions generally does not focus on clinical populations that are seen in pediatric practice-based settings (Drotar, 2002, 2006, 2009). Moreover, most practicing pediatric psychologists are not engaged in research that evaluates the effectiveness of their clinical practices. The net effect of these patterns is continuing isolation of research and practice in pediatric psychology that is also reflected in published work in the Journal of Pediatric Psychology (JPP). Powerful forces have sustained less than optimal integration of research and practice in pediatric psychology. For example, even in the most academically oriented medical settings, fiscal incentives for practitioners focus primarily on clinical care, especially billable hours, rather than on developing practice-based research. Moreover, research funded by the National Institutes of Health (NIH) is generally not conducted in clinical populations because of sampling (e.g., presence of comorbid conditions) and study design considerations as well as the considerable pragmatic obstacles involved in conducting research in practice settings (Drotar et al., 2000). For example, it is very difficult to conduct and sustain research in practice settings given limitations in space, time, and resources (e.g., research assistants, data analytic support, etc.). Heterogeneous clinical practice patterns also make it difficult to achieve the level of experimental control and treatment fidelity that are required for intervention studies. Moreover, NIH review places a premium on testing new intervention models rather than dissemination or clinical application of evidence-based interventions into practice. Based on the above constraints, and to the point of this editorial, research that is published in the JPP focuses on empirical descriptive or explicative research (Roberts, 1992) and randomized trials of intervention rather than case series and clinical effectiveness studies that evaluate the application of interventions conducted in clinical care settings. Such publication patterns reflect the content of manuscripts that are submitted to JPP. In order to shift these publication patterns, I am very interested in encouraging authors to submit clinically relevant research, case reports and series, and studies of clinical effectiveness to JPP. Such research can have important scientific and clinical impact on the field of pediatric psychology. For example, single subject designs and clinical case reports have heuristic value and scientific utility in suggesting new directions for research or clinical care by documenting success or failures of empirically supported interventions in clinical settings, describing the generalizability of research to practice, and evaluating new practice-based interventions (Drotar, 2009; Drotar, LaGreca, Lemanek, & Kazak, 1995). Studies designed to test psychological interventions that improve the power and effectiveness of those conducted in clinical settings will enhance the psychological and health outcomes of children who are seen by practicing pediatric psychologists. Moreover, studies of the comparative effectiveness of alternative interventions should have increased priority under Health Care Reform and for work funded by the Agency of Healthcare Research and Quality. Finally, it is also important to note that the need for greater clinical

Editorial: Case Studies and Series: A Call for Action and Invitation for Submissions

In 1995, the associate editors of the Journal of Pediatric Psychology (JPP) published an article to encourage the submission of case reports, studies, and series (Drotar, LaGreca, Lemanek, & Kazak, 1995), which had been remarkably underrepresented in the portfolio of published articles. Apparently, this article did little to encourage submissions of case studies and series because the situation is unchanged. But being undaunted and persistent, I would like to revisit this issue in light of the continuing importance of case studies and series to the field of pediatric psychology. In its formative years, JPP published many case studies, series, and descriptions of programs (e.g., Bachara & Lamb, 1976; Davidson, Adams, Schroeder, & Tyler, 1978; O’Malley & Koocher, 1977). At that time, pediatric psychologists published such work in order to call attention to important and challenging clinical problems, as well as to share their experiences, ideas, and data concerning clinical practice. Given the state of the art of the science at that time, early case studies and series focused more on description of clinical problems and intervention methods than on empirical demonstrations of treatment efficacy, with some notable exceptions (e.g., Barnard, Christophersen, & Wolf, 1976; Linscheid, Copeland, Jacobstein, & Smith, 1981; Varni, 1980). What conclusion should we draw from the fact that recent submissions to and publications of case studies and series in JPP are so few and far between? Is it the case that the field of pediatric psychology has moved beyond the need for case studies and series to inform clinical practice and research? In fact, the standards for the evaluation of science in our field, including studies of intervention efficacy (Spirito & Kazak, 2006), are much higher now than they were in the early days of the field. Are case studies and series no longer relevant or competitive for publication in JPP? Another possibility is that pediatric psychologists have simply stopped trying to write up their case studies for JPP because they do not see it as a ready outlet for publication. Alternatively, they could be writing them, but submitting them to journals other than JPP. It’s hard to know. As the current editor of JPP, I believe that case studies and series have not outlived their usefulness and that the field of pediatric psychology will continue to benefit from their publication. To address this issue, this editorial has the following goals: (1) underscore the continuing need for the publication of case studies and series in JPP; (2) clarify issues that need to be considered in preparing and reviewing case studies and series; (3) suggest ways to enhance publishability; and (4) invite authors to submit manuscripts that focus on case studies and series.

Introduction to the special issue: psychological aspects of genomics and child health.

Introduction to the special issue: psychological aspects of genomics and child health.

Evidence-based Assessment of Cognitive Functioning in Pediatric Psychology

To review the evidence base for measures of cognitive functioning frequently used within the field of pediatric psychology. From a list of 47 measures identified by the Society of Pediatric Psychology (Division 54) Evidence-Based Assessment Task Force Workgroup, 27 measures were included in the review. Measures were organized, reviewed, and evaluated according to general domains of functioning (e.g., attention/executive functioning, memory). Twenty-two of 27 measures reviewed demonstrated psychometric properties that met "Well-established" criteria as set forth by the Assessment Task Force. Psychometric properties were strongest for measures of general cognitive ability and weakest for measures of visual-motor functioning and attention. We report use of "Well-established" measures of overall cognitive functioning, nonverbal intelligence, academic achievement, language, and memory and learning. For several specific tests in the domains of visual-motor functioning and attention, additional psychometric data are needed for measures to meet criteria as "Well established."

Commentary: Evidence-based Assessment of Pediatric Pain

Commentary: Evidence-based Assessment of Pediatric Pain

Identifying the Classics: An Examination of Articles Published in the Journal of Pediatric Psychology from 1976–2006

The purpose of the present investigation was to identify the top 100 most highly cited "classic" articles in the Journal of Pediatric Psychology, from 1976 to 2006. The Cited Reference search option of the Web of Science(R) was used, which allows for identification of variations in citations. One-hundred and four classic articles ranging in citations from 46 to 192 (M = 71.66, SD = 31.15) were identified. These articles were found to be mostly applied research that focused predominantly on children across several age groups with chronic illness. Citation trends among the classics revealed an inverted-u shape relationship between year since publication and citations per year, which peaked around seven years after publication. The current findings highlight some of the influential works in the field, which have contributed to important advances not only the field of pediatric psychology but other fields as well.

Editorial: Acknowledging the Extraordinary Service and Contributions of the Editorial Board for the Journal

Starting with the first issue of 2008, the Journal of Pediatric Psychology, (JPP) will have a new editorial board with a 3-year term. This change was accomplished to recognize the work of ad hoc reviewers and to involve a diverse editorial board with respect to age, sex, ethnicity, content area of expertize, professional discipline, and country. Congratulations to the new and remaining board members! They are joined by a reviewer panel, which is a new position that was developed to provide interested and promising reviewers with additional experience in reviewers for JPP. We anticipate that the combination of the new editorial board and the reviewer panel will facilitate our abilities to sustain the high level of expertize, quality, and timeliness for JPP. In making this change, it is very important to acknowledge the extraordinary efforts of the editorial board of JPP, most especially those who are rotating off the board. Without naming individuals, some of these board members have held their position for more than 30 years: Now that’s dedication! Editorial board members are truly the unsung heroes and heroines of the community of scholars in the field of pediatric psychology. They spend an extraordinary amount of time on manuscript reviews, all of which is unrecompensed in dollars, in order to enhance the science of the field of pediatric psychology and provide mentorship to authors and other reviewers. The currency that sustains the editorial board’s contributions involves caring, concern, and dedication. They care deeply about the quality of the scholarship and research in the field of pediatric psychology and about providing feedback to scientists about their work. Countless authors have benefited from their work (see my editorial in this issue). On behalf of authors and the field of pediatric psychology, we thank you for your extraordinary dedication and hard work.

Journal of Pediatric Psychology Statement of Purpose—Section on Methodology

study pediatric populations? Are we doing something wrong? Can you help us do it right? If so, you may be able to make an important methodological contribution to this new section of the Journal. More generally, we seek to publish innovative papers focused on any of the following aspects of the research endeavor: the design of research studies, participant sampling methods, measurement and procedural issues, data reduction and data management techniques, data analytic strategies, issues pertaining to data interpretation, and training issues related to research methodology (including issues relevant to grant writing and publishing). We encourage authors to take risks in submitting these papers. Invited commentaries and author rebuttals will be employed to promote discussion of controversial methodological issues. In the special issue on methodology of Noll (2002) in JPP, he included papers on three basic topics: design and methodological issues, novel approaches to research, and contemporary statistical issues. As illustrated in the sections below, we seek papers in areas similar to these: (a) papers that explore new methods or methods that are new to pediatric psychologists, (b) papers that examine new or existing constructs from a novel perspective and in a manner useful for pediatric psychologists, and (c) innovative applications of statistical strategies. In addition to papers that introduce innovative and creative methods to our readership, we also welcome papers that represent critiques of methods and strategies currently in use in the field of pediatric psychology. Finally, papers may be submitted that pose a methodological or statistical ‘‘question’’ that will be of general interest to researchers in the field of pediatric psychology. With respect to the latter, the editor will recruit suitable authors to provide answers to the questions posed.

Editorial: Thoughts on Improving the Quality of Manuscripts Submitted to the Journal of Pediatric Psychology: Writing a Convincing Introduction

I want to share with you some observations and ‘‘things I would like to see’’ in submitted manuscripts that are based on my experience over the last two years as incoming editor of the Journal of Pediatric Psychology (JPP), previous experience in editing and providing reviews, and feedback from JPP’s associate editors. The second in a series of editorials, this one focuses on suggestions to enhance the quality of an introduction to a manuscript. My hope is that this will be useful to authors as well as reviewers in evaluating the quality of manuscripts. Authors face a formidable challenge in crafting a convincing introduction. In a few pages authors need to clarify the relevance of their research to the field of pediatric psychology, specify the focus, primary question, hypotheses, and framework, and establish the significance and new scientific contribution of their work relative to previous research.

Miniseries: Broadening the Scope of Practice and Research in Pediatric Psychology

Over the last several years, the scope of articles published in the Journal of Pediatric Psychology has expanded. Previously, most articles in the Journal involved chronic medical conditions such as cancer, sickle cell disease, and diabetes (B. Aylward, personal communication, March, 2007). However, more recently, two special issues of the journal related to environmental risk of children and adolescents, namely, tobacco and youth, and perinatal drug exposure, have been published. (JPP Vol. 30(4) 2005 & JPP Vol. 31(1) 2006). The evolution in the expanded purview of pediatric psychology is underscored further in the first chapter of The Handbook of Pediatric Psychology (2003) where Roberts, Mitchell and McNeal discuss the evolving field of Pediatric Psychology. These authors note that the discipline of pediatric psychology was developed for pragmatic reasons, because pediatricians continued to be faced with large numbers of behavioral concerns in their young patients. The perceived role of the pediatric psychologist (and our identity in the medical community) was more circumscribed and related primarily to behavioral strategies that would enhance medical adherence or assist with coping and adjustment to the medical condition or environment. However, it is important to highlight, as does Roberts (2003), that ‘‘The growth of pediatric psychology has been a remarkable phenomenon.’’ (p. xvii) Pediatric psychology is, by nature, a multifaceted profession and as such will continue to evolve as its range of practice and research is broadened. Historically, the pediatric psychologists’ focus centered on risk factors ‘‘internal’’ or ‘‘proximal’’ to the child such as depression, anxiety, or emotional disturbances, as well as physical and mental well-being. Using classic psychological theories such as attachment models and social cognition, pediatric psychologists more explicitly included parents (well-being and their parenting practices) in both applied and research endeavors. Over time, foci have expanded from the child to parents, and now extend to address siblings and broader family characteristics. Nonetheless, articles on parents or adolescent populations and the child’s environment in general are still relatively infrequent. The articles by Lam et al. (in press) and Di Clemente et al. (2007) are examples of how pediatric psychology continues to broaden its scope to better address complex issues that affect the developmental trajectories of children today. This broader perspective is also reflected by the ‘‘top issues for the future of pediatric psychology’’ identified in a survey conducted by Brown and Roberts (2000). These issues included expansion to prevention and addressing the larger societal and socioeconomic conditions that affect child development, education, medical care, and psychological services. The evolving challenge for pediatric psychology is to also address these more ‘‘distal’’ risks on children and adolescents, their parents, and family members, and how the total milieu affects the biopsychosocial welfare of the pediatric patient. Notably, contemporary pandemics affecting our children are not cholera or small pox; instead they include pediatric obesity, drug-endangered children, and youth HIV/AIDS. It is reported that 10% of children ages 2 to 5-years-old and 15% of children ages 6 to 11-yearsold are overweight (Ogden, Flegal, Carroll, & Johnson, 2002). In addition, 8.3 million children live with parents who abuse alcohol or other drugs and substance abuse is consistently named as one of the top two problems (the other is poverty) for reports to child protective services (Child Welfare League of America, 2001). Furthermore, >50% of all cases of HIV/AIDS globally are in youth 14–24 years of age (Stine, 2005). The complexity of these pandemics, and our ability to understand and address them goes beyond direct focus

Commentary: A Look at Ourselves in the Mirror

As a pediatric psychologist with some administrative duties, I keep a file of publications about salaries and work expectations of psychologists. Although these reports have more information than just salary data, more often than not I use them to assist with salary and contract benchmarks for my department. Opipari-Arrigan, Stark, and Drotar’s (2005) article adds much to those existing surveys of psychologists in general, because it provides specific information about salaries and work performance of pediatric psychologists. However, the value of this article goes well beyond the salary data presented in Tables 2, 3, 4, 5, and 6. This article echoes the recurrent themes that have defined our field since its inception and that will shape the future of pediatric psychology. It is important for pediatric psychology to take periodic snapshots of these themes, both to provide benchmarks and to develop initiatives to meet future goals. Many key areas are covered by Opipari-Arrigan et al. (2005), but five stand out as recurrent themes for the field of pediatric psychology.

Commentary: Is it Time for Family-Based Interventions in Pediatric Psychology?

Is it time for family-based interventions in pediatric psychology? On the one hand, I am tempted to say that it is not only “time” but past time, particularly given the documented tradition of family systems intervention for children with pediatric illness (Minuchin et al., 1975; Kazak, Rourke, & Crump, 2003). On the other hand, I have a cautionary note to offer: beware of “blind empiricism” in the press for evidence-based intervention. There is a great deal of pressure, led in part by funding priorities, to develop evidence-based interventions (including family interventions for a variety of disorders). The pressure is likely due in part to an appropriate corrective retreat from a previous standard of care that included endless expensive therapies without basis for their effectiveness. It seems to me that this is a very healthy correction. But there is a potential risk in a narrow pragmatic approach to developing effective family-based (or other) interventions. The risk is the tendency to reduce investigation to the level of “blind empiricism,” that is, research that is not framed by well-articulated models. (See Drotar and Lemanek, 2001 for a wellreasoned consideration of various approaches to a clinically relevant science of interventions in pediatric settings.) The articles in this special section take substantial steps in the direction of providing a scientific foundation for the development of targeted evidencebased family interventions for children with pediatric illness. It is exciting to see so many well-articulated studies reported in the same place. What follows below are hopefully useful critiques and suggestions for future investigation and development of a family systems approach within the field of pediatric psychology. Lack of Heuristic Models Guiding Family Intervention Research

Longitudinal Research in Pediatric Psychology: An Introduction to the Special Issue

This issue of the Journal of Pediatric Psychology (JPP) includes articles submitted for a special issue on “Longitudinal Research in Pediatric Psychology.” In the Call for Papers, we sought empirically oriented manuscripts that employed longitudinal designs and theoretical, methodological, or statistical papers relevant to longitudinal research. Examples of potential topics were provided in the Call and included: (a) familial, peer, and/or other contextual predictors of subsequent change in health-compromising behaviors in typically developing children or change in health-related behaviors and processes in children with chronic illness, (b) the impact of chronic illness on normative development or the consequences of varying developmental trajectories for subsequent health-related behaviors and processes, (c) studies that isolate different health trajectories as well as predictors of such differential outcomes, (d) tests of prospective mediational or causal predictor models based on longitudinal data, and (e) prevention, health promotion, and intervention studies with multiple data collection points that identify intervening mechanisms of change in health outcome. In response to the Call for Papers, 15 manuscripts were submitted. This issue includes eight of these articles; the first focuses on statistical strategies that can be used with longitudinal data and the other seven papers are empirical studies. Longitudinal studies permit examination of changes in health-related behaviors and processes over time. Such designs can be retrospective or prospective, with the latter having clear advantages over the former (Loeber & Farrington, 1994). As will be argued in more detail below, prospective longitudinal investigations of children with chronic physical conditions may be particularly informative when change is examined during critical developmental periods or transition points (e.g., early childhood, the transition to school, the early adolescent transition, the transition to adulthood). Indeed, a chronic condition is “chronic”; the impact of the condition is likely to unfold over time. At the most complex level of analysis, the task for the researcher is to understand a chronic condition that is changing over time in an individual that is also changing, developing, and maturing over time. Despite the advantages of longitudinal designs in addressing such issues, most studies in the fields of clinical child psychology and pediatric psychology are not longitudinal. In an earlier special issue of the Journal of Consulting and Clinical Psychology (JCCP) on “The Role of Longitudinal Data with Child Psychopathology and Treatment,” Wierson and Forehand (1994) conducted a review of articles published on children and adolescents between 1983 and 1992 and found that only 4% were longitudinal (with 13% of those in JCCP being longitudinal). Of course, not all research questions require longitudinal designs, but Wierson and Forehand’s (1994) review suggests that such designs are more the exception than the rule. Within the field of pediatric psychology (and in JPP, in particular), most scholars suggest in their “future directions” sections that longitudinal data would be beneficial. Indeed, Wallander and Varni (1998) argued that developmentally oriented longitudinal studies in the field of pediatric psychology would be informative: “General developmental processes should become more salient features of the conceptualizations of adjustment in this special group. Longitudinal designs need to become the norm” (p. 42). In this introductory article, we first discuss advantages of longitudinal research in the study of children and adolescents with chronic conditions. Next, we provide an overview of several factors one may wish to consider when designing longitudinal studies with pediatric populations. Finally, we provide a brief overview of the articles included in this special issue.