In this issue
Recollections of the Beginning of Pediatric Psychology
By Richard R. Abidin
Some psychologists may see pediatric psychology as a field created initially by psychologists themselves to serve the needs of children and families in pediatric and primary health care settings. My own recollection and personal experiences suggest that pediatricians and other physicians serving families in pediatric and medical settings also recognized the need for the field. These medical professionals found they were not prepared themselves to deal with the many psychological, developmental, and family issues experienced by patients. Furthermore, they often did not have the time to address what were seen as non-medical problems . Consequently, these medical professionals were eager for the involvement and assistance of other professionals who would help them better serve their patients. This was most notable in government supported settings but was also true in private pediatric practices. Thus, credit for the creation of the pediatric psychology field is shared with our medical colleagues. There appear to have been multiple actions across the country, some independently, some in concert with others that helped move pediatric psychology concepts and services forward.
In my personal experience, in 1964, I was assigned to the Department of Psychiatry, Wilford Hall USAF Hospital in San Antonio for my internship in clinical psychology for three years. Wilford Hall was a large medical facility serving Air Force personnel and their families. Given my background in both clinical and school psychology, I was assigned to work primarily in the child psychiatry area.
Within weeks of my appointment, the chairman of the Department of Pediatrics, Col. Thomas M. Holcomb M.D. requested that I speak to the Pediatrics residents regarding normal child development and signs of deviation from typical development. Following the presentation, I was asked if I would be willing to consult with the residents and staff about developmental and mental health issues, and I became an instant consultant who had no prior experience consulting with medical personnel, although I had consulted with teachers. Later, the pediatric staff and residents requested that I be assigned part-time to the pediatric department and I served half time in that assignment. Also, with the support of Dr. Holcomb, I developed a one month behavioral pediatrics rotation that by May 1966 was completed by four pediatric residents.
On August 26,1966, I received a letter from John McK. Mitchell, M.D., the executive secretary of the American Board of Pediatrics, Inc., in response to my inquiry regarding whether there were guidelines for a third year of pediatric residency training aimed at behavior problems. His response in part was, "I regret to say that at the moment I am not in any position to give you the sort of material that I gather you want. However, an ad hoc committee on this very topic has recently been set up under the combined leadership of Dr. Howell Wright, president of the American Board of Pediatrics and Dr. Robert Stubblefield representing the Committee on Certification I Child Psychiatry of the American Board of Psychiatry and Neurology."
After showing this response to Dr. Holcomb, he requested that I prepare a report based on our Wilford Hall experiences so that he would be able to share it with the American Board of Pediatrics and with some of his other colleagues. He said "Dick, we are leading the field on this." In June of 1966, I submitted the report describing the history of the Developmental Pediatrics rotation at Wilford Hall to Dr. Holcomb, the title of which was: "Recommendations for a Child Psychology—Problems in Behavior, Integrated Sequence in a Three-year Pediatric Residency Program." While there is no documentation to support the claim, the report may have been the first proposal and curriculum outline designed for the training of pediatricians in behavioral pediatrics.
Following this experience, in September of 1967, I became employed at the University of Virginia (UVA), tasked with starting a new doctoral program in School and Clinical Child Psychology. On a visit to our children's pediatrician, Dr. Charles Gleason informed me that the head of the Department of Pediatrics at UVA hospital, Dr. Bill Thurman, had spoken to him about me. It turned out that Dr. Holcomb and Dr. Thurman were close friends. Dr. Gleason then invited me to meet with the pediatricians of Pediatrics Associates of Charlottesville and, as at Wilford Hall, a long period of collaboration began.
Some readers may recognize me as the author of the Parenting Stress Index (PSI), but the initial idea for the development of a screening and diagnostic measure designed for pediatric practices came from Julian Haber M.D., while he was a pediatric resident at Wilford Hall Hospital. Turning the idea into a reality was a result of the support of the pediatricians at Pediatric Associates of Charlottesville who allowed me to create the "Parenting Clinic" within their practice. The clinic was established with the help of Lon Shackelford, Ph.D. and Bill Burke, Ph.D. We provided clinical services to parents, consultation to the physicians, and were able to collect data for the development of the PSI. During the 1970s, we developed a model of integrated service delivery that pleased the pediatricians, and Dr. Schackelford continues to work in the practice.
Similar activities appeared to be occurring across the country, although no formal entity existed to organize the developments, such as the Society of Pediatric Psychology, which was founded after 1969. In sharing the above thoughts, I hope it is clear that the field of pediatric psychology was the result of the joint efforts of psychologists and pediatricians who recognized the need and used their administrative power to encourage psychologists to use their skills, knowledge, and creative energy for the betterment of children and families.
Richard R. Abidin is professor emeritus at the University of Virginia and is the founder of the Curry programs in clinical and school psychology. He is a clinical child, pediatric, school psychologist and worked in those fields through out his career. Working through others as a consultant to parents, teachers, and physicians is his practice of choice. He has authored a number of psychological measures, Parenting Skills programs, and family and school research articles.