Large language model applications for pediatric psychology.

When are surgical care innovations not surgical?

Disorders (or differences) of sex development (DSD) represent a broad spectrum of rare congenital conditions characterized by atypical development of atypical development of chromosomal sex, gonadal differentiation, or internal and/or external genital anatomy. Although some individuals are identified in early life, a substantial proportion first present during adolescence, frequently with delayed or absent pubertal development, primary amenorrhea, virilization, or questions regarding gender identity or fertility. This sensitive developmental phase is accompanied by increasing autonomy, necessitating a patient-centred approach with transparent communication and shared decision-making. In this paper, we describe our structured, stepwise diagnostic pathway for adolescents presenting with suspected DSD, embedded within a specialized multidisciplinary team including paediatric endocrinology, laboratory medicine, clinical genetics, psychology, radiology, and surgical expertise. Advances in biochemical profiling, imaging techniques, and genetic testing have improved diagnostic accuracy; nonetheless, psychosocial guidance remains essential throughout the process to support understanding, coping, and long-term well-being. To contextualize this approach, we present an illustrative adolescent case highlighting key clinical considerations, communication strategies, and the specific roles of each team member. Through this case-based framework, we aim to provide clinicians with clear and clinically applicable guidance for the coordinated evaluation and management of adolescents with DSD, emphasizing individualized, developmentally appropriate and gender-affirming care.

Objective: Inequities in accessing waitlisting for liver and kidney transplantation among pediatric and adult populations are well-documented, with disparities related to race, ethnicity, and socioeconomic status consistently present in both settings. Historically, studies examining barriers to transplant waitlisting have focused mainly on patient and family demographics. However, due to the complexity and subjectivity of pretransplant evaluations, other factors (e.g., provider biases) likely influence waitlisting decisions. This topical review brings awareness to how provider biases toward race, ethnicity, and socioeconomic status may impact access to pediatric liver and kidney transplant waitlisting. Methods: Searches using keywords such as ethnic and racial minorities, waiting lists, transplantation, poverty, and pediatrics were conducted in https://inPubMed.gov , CINAHL Complete (EBSCO), PsychINFO (EBSCO), https://Embase.com , https://Scopus.com , and Web of Science databases with no relevant findings including provider bias in pediatric liver or kidney transplant. A second search in only PubMed with no limit by age produced four relevant articles between 2004 and 2023. Results: Provider biases within the pretransplantation evaluation and waitlisting processes have been explored in adult populations and are starting to be explored in some pediatric subspecialties, though gaps remain in pediatric liver and kidney transplantation. Conclusions: Pediatric kidney and liver transplant waitlisting may be impacted by provider biases throughout the evaluation process. More research is needed to determine areas of susceptibility and how to reduce bias throughout the subjective processes of transplant evaluation. We provide recommendations for how pediatric psychologists can use their skillsets to decrease bias and advance equity in pediatric liver and kidney transplantation settings.

ABSTRACT Objectives As the number of ethnic/racial minority individuals in the United States continues to grow, psychology programs need to train a representative workforce that can meet the needs of an increasingly diverse population. This survey study explored (a) the approaches used by clinical child and pediatric psychology programs to train students in multicultural education and (b) the strategies and barriers to recruit and retain underrepresented students and faculty. Method The survey was developed by the Diversity Committee of the Clinical Child and Pediatric Psychology Training Council (CCaPPTC) and was sent to directors from various CCaPPTC-member graduate, internship and postdoctoral training programs across the nation. Responses to open-ended questions were coded, and thematic analysis was used to group the codes into meaningful categories. Bronfenbrenner’s Ecological Systems Model and the Layered Ecological Model of the Multicultural Guidelines (APA, 2017) were used to structure the analysis. Results A total of 42 directors (71% response rate) completed the survey. Thirty-seven codes categorized into 10 themes, nested within four ecological levels (micro-, meso-, exo- and macrosystems), were identified. Derived themes capture specific approaches and strategies programs used to teach diversity and recruit/retain underrepresented students and faculty. Conclusion Findings highlight the importance of developing strategies at various levels of the system to enhance curriculum and recruitment/retention efforts, as well as the need to attend to the interactions between systems in order to address barriers. Specific recommendations are offered.

Pediatric psychology is a specialized branch of psychology that focuses on the emotional, behavioral, and developmental well-being of children from infancy through adolescence. It bridges two worlds-medicine and psychology-to ensure that a child’s mental health is understood within the context of their physical health, family environment, and social experiences.

Differences of sex development (DSD) are congenital conditions in which chromosomal, gonadal, and anatomical sex characteristics are discordant with typical male or female development. These clinical practice guidelines provide evidence-based recommendations for the diagnosis and management of individuals with DSD across the lifespan. The guidelines were developed by a multidisciplinary committee of specialists representing pediatric endocrinology, adult endocrinology, urology, gynecology, psychiatry, and psychology. The committee employed a systematic review of the literature and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of evidence. Key areas addressed include the initial management of infants with atypical genitalia, diagnostic approaches, hormonal treatment, surgical interventions, gonadal tumor risk assessment, fertility preservation, and the transition from pediatric to adult care. The guidelines integrate international best practices with Japan's unique sociocultural, healthcare, and legal contexts for optimal DSD management and aim to improve clinical care for individuals with DSD while acknowledging the limited high-quality evidence in many aspects of DSD management.

For children with avoidant/restrictive food intake disorder (ARFID), research on factors contributing to elevated BMI is lacking. Using a sample of children diagnosed with ARFID through an outpatient, multidisciplinary feeding clinic, this study aimed to identify the proportion of children within each BMI category, compare fruit and vegetable (FV) intake between children with sensory sensitivity and non-sensory sensitivity ARFID, and determine whether FV intake was associated with BMI. Data were collected retrospectively from an outpatient, multidisciplinary feeding clinic. The sample included 271 children (2-18 years; Mage = 6.71, SD = 3.05) and one parent/legal guardian per child who completed a feeding evaluation. Child height/weight, demographics, FV checklist, and two items assessing FV intake from the Behavioral Pediatrics Feeding Assessment Scale were collected. A pediatric psychologist established ARFID diagnosis using a multi-method approach. Classifications of underweight, healthy weight, overweight, and obesity were 9.6%, 64.9%, 11.4%, and 14.0%, respectively. No differences were found in average FV intake between children with sensory sensitivity ARFID versus those with non-sensory sensitivity ARFID. Accounting for relevant covariates, lower FV intake (number of accepted FVs but not frequency of FV intake) was significantly associated with higher BMI z-score. Findings support the existence of ARFID across the BMI spectrum and suggest that among children with ARFID, those with fewer accepted FVs may present with higher BMI. Food selectivity may be a valuable intervention target, particularly among youth with higher BMI. Further research is needed to elucidate factors relevant to BMI in children with ARFID.

Tele-pediatrics has transformed caregiver–clinician communication, introducing new patterns of trust formation in remote child healthcare. This paper conceptualizes trust as a co-created process shaped by emotional responsiveness, communication reliability, and participatory interaction in virtual pediatric settings. Drawing on evidence from pediatric psychology, behavioral communication, and telehealth studies, a multidimensional framework is proposed with three interrelated components: interactional consistency, perceptual authenticity, and collaborative assurance. These constructs explain how caregivers interpret empathy, competence, and partnership during digital consultations. The framework highlights that trust in remote pediatric care extends beyond technical expertise, emerging through consistent communication and visible emotional understanding. It also identifies challenges such as depersonalization and reduced empathy in high-volume digital environments. The model offers theoretical insight into how trust evolves in technologically mediated healthcare and practical guidance for training clinicians to communicate emotional presence effectively through digital interfaces. Future work should include empirical validation through qualitative observation and caregiver narratives to assess the model’s relevance across diverse cultural and healthcare contexts

As the incidence of mass casualty incidents (MCIs)-including natural disasters, acts of terrorism, and mass shootings-continues to rise worldwide, the need for health care institutions to develop comprehensive MCI response plans, particularly those that incorporate a dedicated mental health component, has become increasingly urgent. A crucial component of these response plans is ensuring that mental health providers are adequately trained, resourced, and prepared to respond by maintaining a foundational competence in disaster mental health. This article reviews definitions of mass casualty and community disasters, explores psychological outcomes, and presents evidence-based interventions that can be used in the aftermath. It highlights the role of psychology in both immediate and long-term mental health responses, with a particular focus on pediatric psychology. Additionally, we discuss the importance of program development and the clear delineation of administrative roles in responding to MCIs. Our review is grounded in the real-world experience of a pediatric psychology response to a specific MCI that occurred at a Level 1 pediatric trauma center and lessons learned through this experience. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

ObjectivesThis study examined the prevalence of major depressive disorder (MDD) and associated factors among children and adolescents aged 10-16years attending a Pediatric Psychology and Psychiatry Department in Vietnam.MethodsA cross-sectional study was conducted from February to June 2025. Patients aged 10-16years were recruited and assessed via structured interviews with caregivers for sociodemographic information, childhood trauma, and parent-child relationship. Depression was diagnosed using DSM-5-TR criteria.ResultsAmong 199 eligible participants, 26.6% were diagnosed with MDD. In the multivariable model, female gender (AOR = 10.3, 95% CI: 2.8-38.0, p < .001), emotional neglect (AOR = 9.9, 95% CI: 3.4-28.7, p < .001), physical neglect (AOR = 6.1, 95% CI: 2.2-17.0, p < .001), physical abuse (AOR = 4.4, 95% CI: 1.3-15.5, p = .020), and sexual abuse (AOR = 7.3, 95% CI: 1.3-15.5, p = .004) were independently associated with MDD. Household economic status and parent-child relationship were not significant after adjustment.ConclusionOver one-quarter of children and adolescents seeking psychiatric care met diagnostic criteria for MDD, with risk shaped by family environment and adverse childhood experiences. These findings highlight the need for screening of at-risk subgroups and targeted interventions addressing family functioning and trauma history.

Cardiological conditions in adolescents can impair health-related quality of life (HRQoL), influencing physical, emotional, and social functioning. Identifying sociodemographic and psychosocial determinants is essential for targeted multidisciplinary interventions involving pediatric cardiologists, nurses, and psychologists. This study assessed HRQoL in hospitalized adolescents with cardiologic problems. A cross-sectional study was conducted among 100 adolescents aged 11-18 years hospitalized in a pediatric cardiology ward in Poland (June-December 2022). HRQoL was measured using the validated Polish version of the KIDSCREEN-52 questionnaire. Data on demographics, family and financial situation, and pain were collected. Non-parametric tests and Spearman's correlations were applied; p < 0.05 was considered significant. The highest HRQoL scores were observed in Social Acceptance (mean 86.3 ± 17.9), while the lowest scores were found in School Environment (49.2 ± 21.4). Boys had significantly higher Physical Well-being and Self-perception scores than girls (p = 0.019, p = 0.031). Older age correlated negatively with Moods and Emotions (r = -0.216, p = 0.031) and Peer Relationships (r = -0.300, p = 0.002). Rural residence was associated with stronger family relationships (p = 0.025). A better financial status correlated with higher family relationship and financial resource scores. Pain was linked to poorer physical and emotional well-being. The health-related quality of life (HRQoL) of adolescents hospitalized for cardiac conditions is mainly affected by socio-demographic factors, such as gender, age, place of residence, perceived socioeconomic status, and experiences of pain and discomfort. Girls, older adolescents, urban residents, and those reporting poorer socioeconomic conditions and pain had lower HRQoL scores in specific areas. Conversely, family structure and the presence of chronic diseases did not significantly influence HRQoL outcomes.

This narrative review offers a unique contribution by examining school physical education (PE) as a psychosocial intervention for children recovering from cancer an area that remains markedly underexplored in current literature. Existing reviews focus largely on hospital-based or clinically delivered exercise programmemes, with limited attention to how everyday school environments, particularly PE classes, can support emotional recovery, peer reconnection, and social adaptation. By integrating evidence from paediatric oncology, sport science, psychology, and educational research, this review introduces a new interdisciplinary framework that conceptualises school PE not merely as physical activity, but as a therapeutic space that fosters resilience, restores normalcy, and facilitates reintegration into school life. This work is one of the first to propose structured recommendations for school-based PE participation, thereby addressing a critical gap in survivorship care and offering practical directions for educators, clinicians, and policymakers.

Abstract Awake Brain surgery is a procedure in which a patient is awake during the whole or a part of the procedure, for intra-operative mapping for eloquent areas and resection of tumor. In adults, although it is the standard of care for resection in eloquent areas, in pediatric population, it is difficult due to various reasons including procedural difficulty and psychological variability in children. We report a six-year-old right-handed boy presented to us in neurosurgery clinic with the history of partial seizures involving left side of the face and hand, since 2 years of age. He was on three antiepileptics including phenobarbitone, carbamazepine and levetiracetam. On examination, he was a very pleasant boy, awake, alert, oriented to time, place and person. Higher mental functions including long and short-term memory, speech, repetition, and recognition of pictures were normal. There were no motor or sensory deficits in cranial nerve examination and neurological examination of the limbs. MRI revealed a hyper-intense lesion on T2-weighted and FLAIR sequences, contrast-non-enhancing on T1-contrast sequences, in right Frontal lobe in the pre-motor area, abutting and causing pressure on the pre-central gyrus. After consultations with specialist pediatric psychologist, neurologist, neuro-oncologist,s and awake anaesthesia consultant for pre-operative evaluations, he underwent underwent asleep-awake-asleep surgery. Intra-operative mapping was done, the child was in conscious sedation throughout, his left upper and lower limb activities were monitored during mapping and resection of the tumor. The child did not develop any new post-operative deficits. Post operative MRI showed more than 90% of the tumor resected. CONCLUSION This patient is the youngest child to undergo awake brain tumor surgery reported in the published medical literature yet. Awake craniotomy is feasible and if able to tolerate, makes it possible to do maximum possible resection without causing any lifelong disability to the child.

Psychodermatology addresses the interaction between cutaneous disease and psychological conditions. The Coping Clinic at Boston Medical Center (BMC) provides interdisciplinary psychodermatology care where pediatric patients see a dermatologist and a psychologist in the same visit. This study's purpose was to preliminarily assess the scope and impact of collaborative care between pediatric dermatology and psychology. A retrospective chart review of 50 patients (94 charts) examined the reasons for referral, dermatologic and psychiatric diagnoses, treatment recommendations, and interventions made in the Coping Clinic from 2018-2023. Of the 50 patients seen, 62% (31/50) were female and 38% (19/50) were male, with a mean age of 13.2 years. The most common dermatologic diagnoses were atopic dermatitis (32%; 16/50) and acne vulgaris (30%; 15/50). Excluding those diagnosed with adjustment disorder, 72% (36/50) of patients received new psychological diagnoses at Coping Clinic, the most common being anxiety (34%; 17/50) and depression (12%; 6/50). Sixty-four percent (32/50) of patients were referred to therapy after being seen in Coping Clinic, and 28.1% (9/32) met with a mental health provider at least once. As documented in the psychologist's notes, 80% (12/15) of patients had signs of improved mood at their follow-up visits. All Coping Clinic patients received new psychological assessments and plans or a referral to Behavioral Health along with continuity in dermatology care. While we cannot prove from this chart review that improvement in mood was specifically related to attending Coping Clinic, these results demonstrate the feasibility of interdisciplinary pediatric psychodermatology care in an urban safety-net hospital.

Academic health center (AHC) psychologists finding novel leadership pathways, both within and outside their AHCs, can provide valuable opportunities for professional enrichment and growth. In this manuscript, we describe how psychologists' training, experiences, and skills contribute to leadership success in traditionally medically-led organizations (MLOs). We also describe how four ACH pediatric psychologists, all at different career stages, found unique leadership roles within traditionally medically-led organizations (MLOs). For each leadership role example, we describe (1) how career stage, expertise, and values intersect with the leadership opportunity, (2) the psychologist's organizational context and leadership role structure, and (3) the psychologist's leadership contributions and collaborative strategies. We also provide concrete recommendations to other ACH psychologists who wish to explore leadership roles throughout their careers.

The psychology pre-transplant evaluation is an integral component of the pediatric transplant process and serves to identify both risk and resilience factors that may contribute to peri- and posttransplant outcomes. Despite guidelines with general considerations, the pediatric pre-transplant psychological evaluation is not standardized. This study presents results from a practice survey of pediatric transplant psychologists to inform the standard of care. A workgroup of members of the Society for Pediatric Psychology Solid Organ Transplant Special Interest Group designed a survey assessing pre-transplant psychological evaluation practices. A total of 88 psychologists were identified and asked to complete the survey. Descriptive statistics were used to summarize survey results. Forty-seven psychologists representing 38 medical centers provided complete responses. Respondents represented multiple solid organ groups: 70% kidney, 68% heart, 47% liver, 19% lung and multi-visceral respectively, 13% intestinal, and 9% pancreas. Psychology is routinely involved in evaluations, though psychology evaluation practices are impacted by various barriers (e.g., time, insurance) and patient characteristics (e.g., medical acuity, age). The most commonly assessed domains were developmental history, allocation of treatment responsibility, social history, patient psychiatric history, motivation for transplant, understanding of transplant, treatment adherence, and medical coping. Although domains assessed were largely consistent among respondents and represented important risk and resilience domains, there was reported variability in the role of psychology on selection committees and listing decision-making. Despite a lack of standardization of the pre-transplant psychological evaluation, areas of consistency exist. However, variability in practice among pediatric solid organ transplant centers remains, necessitating the development of a common foundation for the pre-transplant psychological evaluation. Results also emphasize the importance of psychology's role within pediatric transplant teams.

Increasing numbers of caregivers in the United States face challenges caring for children with special health care needs. Research has identified unique challenges for caregivers, including limited resources and mental health issues. Caregiver burden involves various strains from the ongoing care of a loved one. This scoping review explored the emotional, financial, physical, and social dimensions of burden among caregivers of children with multiple conditions. It also examined study characteristics, measurement tools, and associations among constructs. A scoping review followed PRISMA-ScR guidelines using PubMed and PsycINFO for literature searches focused on caregiver burden and experiences. Eighteen studies met inclusion criteria with three categories emerging: studies on children with medical complexity (n = 3), varied pediatric conditions (n = 7), and specific conditions (n = 8). Significant associations between caregiver burden and the number of co-occurring conditions were noted overall, as well as differences in burden for caregivers of children with and without co-occurring conditions. This review discusses the general findings, strengths, and limitations of the existing body of research. Future research should aim for more diverse samples and assess caregiver burden longitudinally. Pediatric psychologists should work to assess and reduce caregiver burden in families, especially for caregivers whose children have multiple diagnoses.

Objective: Issues of diversity, equity, and inclusion have risen to the forefront of pediatric psychology. However, chronic illness identity has not been explicitly acknowledged in these efforts. With this commentary, we highlight the unique strengths of and challenges experienced by pediatric psychologists and trainees living with chronic illness, reflecting on extant literature when available and closing with a call to action to direct research, resources, and policy. Methods: Fifteen members of the Society of Pediatric Psychology (SPP) Chronic Illness Affinity Group, including nine trainees and six faculty, who hold lived experience across a range of medical conditions, convened to write this commentary. Five key domains are reviewed and reflected on: intersectionality, logistical considerations, disclosure, stigma, and emotional impact. Results: We have all faced considerable challenges while navigating chronic illness in our dual roles as patients and pediatric psychologists/trainees, yet our experiences have also equipped us with substantial strengths across professional settings. To our knowledge, no prior published work has specifically explored the lived experience of psychologists/trainees with chronic illnesses. Conclusions: Further work must examine and address the needs of pediatric psychologists and trainees with chronic illnesses. We recommend (1) acknowledging the prevalence and needs of pediatric psychologists and trainees impacted by chronic illness, (2) providing resources for support across settings, and (3) increasing representation of chronic illness identity in diversity, equity, and inclusion efforts. With these actions, we hope that holding lived experience with chronic illness is eventually seen as a unique personal and professional asset within pediatric psychology.

BackgroundNon-suicidal self-injury (NSSI) is a common malpractice in adolescents with mental disorders. It may lead to suicide or other adverse consequences, thus affecting the treatment and rehabilitation of patients. We herein analyzed the relationship among family resilience, emotional intelligence, and NSSI behavior in adolescents with mental disorders.MethodsWe conducted a cross-sectional survey of 294 adolescent patients with mental disorders (91 boys and 203 girls) from the counselling center and inpatient adolescents of the Pediatric Psychology Department of Hunan Brain Hospital. Data were collected using the Family Resilience Scale, Emotional Intelligence Scale, and Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. Structural equation modeling (SEM) was used to explore the mediating role of emotional intelligence in the association between family resilience and NSSI in these adolescents.ResultsHerein, 229/294 patients reported at least one episode of NSSI behavior in the last one year. They had low levels of family resilience and emotional intelligence. Family resilience and emotional intelligence were significantly negatively correlated with NSSI behavior; consequently, they showed a significant association with NSSI behavior. The SEM analysis showed that emotional intelligence plays a partial mediating role in the relationship between family resilience and NSSI.ConclusionFamily resilience and emotional intelligence are important protective factors for NSSI behaviors in adolescent patients with mental disorders. Future research can focus on stimulating the ability of adolescent patients with mental disorders to combine the strengths of their own and their family’s resources, find the right direction for their individual development, and promote their treatment and recovery.