A prática psicológica e a ludicidade na hospitalização pediátrica: relato de experiência / Psychological practice and playing in pediatric hospitalization: experience report / La práctica psicológica y la ludicidad en la hospitalización pediátrica: informe de experiencia

INTRODUÇÃO: A inserção da psicologia e o método lúdico de intervenção na esfera hospitalar surge para promover bem-estar frente às vivências das crianças em condição de internação. O enfrentamento de uma hospitalização no período da infância pode provocar impactos significativos do ponto de vista orgânico, psíquico e ambiental, por ser um momento de estruturação do indivíduo enquanto sujeito psíquico. OBJETIVO: Posto isso, o presente artigo objetiva refletir sobre a relação da família e da equipe de saúde com crianças hospitalizadas e a relevância da utilização dos recursos lúdicos, a partir de um relato de experiência de estagiários de um curso de graduação em psicologia. MÉTODO: Logo, trata-se de um relato de experiência, de abordagem qualitativa e de natureza descritiva, realizado de março de 2022 a junho de 2023, em uma Unidade Pediátrica de um Hospital Público Brasileiro. RESULTADOS E DISCUSSÃO: A partir disso, observaram-se na prática reações de estranhamento dos pacientes ao se depararem com a permanência no hospital, o adoecimento e os procedimentos das equipes multiprofissionais de saúde; bem como evidenciou-se a importância da transmissão das informações e do preparo verbal ante intervenções, visando a participação ativa do paciente em seu tratamento. Também observou-se a significância do uso de ferramentas lúdicas nas intervenções com as crianças, que facilitam a adaptação ao contexto e proporcionam âncora para estas elaborarem suas vivências. CONCLUSÃO: Portanto, conclui-se que a utilização de recursos lúdicos favorece o atendimento psicológico na infância e período de hospitalização.

INTRODUCTION: The integration of psychology and the playing method of intervention in the hospital setting emerges to promote wellbeing in the face of children's experiences during hospitalization. Confronting hospitalization during childhood can lead to significant impacts from organic, psychological, and environmental standpoints, as it represents a pivotal moment in the individual's psychological development. OBJECTIVE: With this in mind, the present article aims to reflect on the relationship between families and healthcare teams with hospitalized children and the relevance of using playful resources, based on an experience report from interns of an undergraduate psychology course. METHOD: Therefore, it constitutes an experiential account, employing a qualitative and descriptive approach, conducted from March 2022 to June 2023, in a Pediatric Unit of a Brazilian Public Hospital. RESULTS AND DISCUSSION: From this perspective, practical observations revealed patients' feelings of unfamiliarity upon facing hospital stays, illness, and procedures performed by multidisciplinary healthcare teams; as well as the significance of conveying information and verbal preparation before interventions was highlighted, aiming to actively involve the patient in their treatment. It was also observed the significance of using playful tools in interventions with children, which facilitates adaptation to the context and provides an anchor for them to elaborate on their experiences. CONCLUSION: Thus, it can be concluded that the use of playful resources enhances psychological care during childhood and the hospitalization period.

INTRODUCCIÓN: La inserción de la psicología y el método lúdico de intervención en el ámbito hospitalario surge con el propósito de promover el bienestar frente a las experiencias de los niños en condiciones de hospitalización. Enfrentar la hospitalización durante la infancia puede generar impactos significativos desde un punto de vista orgánico, psicológico y ambiental, ya que representa un momento de estructuración del individuo como sujeto psíquico. OBJETIVO: En este sentido, el presente artículo tiene como objetivo reflexionar sobre la relación de la familia y el equipo de salud con niños hospitalizados y la relevancia de utilizar recursos lúdicos, a partir de un relato de experiencia de practicantes de un curso de grado en psicología. MÉTODO: Por lo tanto, se trata de un informe de experiencia con enfoque cualitativo y de naturaleza descriptiva, llevado a cabo desde marzo de 2022 hasta junio de 2023 en una Unidad Pediátrica de un Hospital Público Brasileño. RESULTADOS Y DISCUSIÓN: A partir de esto, se observaron reacciones de desconcierto por parte de los pacientes al enfrentar la permanencia en el hospital, la enfermedad y los procedimientos realizados por los equipos de salud multidisciplinarios; así como también se resaltó la importancia de la transmisión de información y la preparación verbal antes de las intervenciones, con el objetivo de involucrar activamente al paciente en su tratamiento. También se observó la importancia del uso de herramientas lúdicas en las intervenciones con niños, ya que facilitan la adaptación al contexto y brindan un punto de referencia para que estos niños elaboren sus experiencias. CONCLUSIÓN: Por lo tanto, se concluye que el uso de recursos lúdicos favorece la atención psicológica durante la infancia y el período de hospitalización.

Commentary: Integrative, multi-level explanatory models are needed to understand recent trends in sex, gender, and internalizing conditions, reflections on Keyes and Platt (2023).

Keyes' and Platt's (The Journal of Child Psychology and Psychiatry, 2023) review provides much-needed systematic evidence about why internalizing symptoms have increased and it clarifies the role of novel risk factors. The findings highlight that multiple factors at multiple levels are responsible for this phenomenon, many with small effects, within a complex interplay that is rarely well captured. As new insights emerge across disciplines, an important step is to renew efforts to integrate them to understand how internalizing symptoms develop for different people.

Do school and equality education characteristics influence young children's understanding of sex/gender constancy?

In many cognitive developmental studies, young children ( < 6 years) fail to understand that changing the appearance of a person, object, or animal does not change its underlying reality. They appear to believe that a cat wearing a dog mask is genuinely a dog (appearance/reality distinction) and that a boy wearing a dress is genuinely a girl (sex/gender constancy). These skills may be affected by various influences: testing methods, training on the constancy of biological traits, child's or sibling's diagnosis of gender dysphoria, and child's diagnosis of autism. This study aimed to partially replicate the study of Arthur et al. (Journal of Experimental Child Psychology, 2009, Vol. 104, pp. 427-446) showing that experimental lessons emphasizing the constancy or otherwise of biological traits affected appearance/reality and sex/gender constancy performance. The study examined the influence of school lessons with content on sex/gender stereotyping and pro/anti constancy on the performance of young English children (mean age = 5;6 [years;months]; N = 58) on appearance/reality and sex/gender constancy tasks. Children performed above chance on sex/gender stability (change over time) but performed below chance on sex/gender constancy and appearance/reality tasks (change due to superficial alterations). These scores are comparable to those in nearly all previous studies. Children's scores were not influenced by school lesson content, although not all schools provided content. Conclusions are drawn about the effect of lesson content, which may be too diffuse and long term to affect performance. The level of children's performance and what this means in absolute terms about children's understanding of sex/gender stereotypes and the possibility of a child changing sex/gender is also discussed.

Editorial: Generative artificial intelligence and the ecology of human development.

Commercial applications of artificial intelligence (AI) in the form of Large Language Models (LLMs) and Generative AI have taken centre stage in the media sphere, business, public policy, and education. The ramifications for the field of child psychology and psychiatry are being debated and veer between LLMs as potential models for development and applications of generative AI becoming environmental factors for human development. This Editorial briefly discusses developmental research on generative AI and the potential impact of generative AI on the hybrid social world in which young people grow up. We end by considering that the rapid developments justify increasing attention in our field.

Commentary: Cognitive stimulation and executive functions in the prevention and treatment of childhood disorders - reflection on Phillips et al., 2023.

The study by Phillips et al. (Journal of Child Psychology and Psychiatry, 2023) shows that preschool executive functions (EF) are a transdiagnostic mechanism through which deprivation increases the risk for psychopathology in adolescence. In addition, deprivation appeared to be a key mechanism through which economic adversity (i.e., lower income-to-needs ratio and maternal education) undermines EF and increases the risk for psychopathology in adolescence. In this commentary, implications for early prevention and treatment of childhood disorders are discussed. In view of optimal EF development attention is needed to cognitive and social stimulation both in: (a) selective prevention targeting preschool children at high risk for childhood disorders due to low socioeconomic status; (b) indicated prevention targeting preschool children with minimal but detectable symptoms from low socioeconomic status families; and (c) treatment targeting preschool children with a clinical disorder from low socioeconomic status families.

Prolonged development of forced-choice recognition when targets are paired with non-corresponding lures.

Previous research suggests that mnemonic discrimination (i.e., the ability to discriminate between previously encountered and novel stimuli even when they are highly similar) improves substantially during childhood. To further understand the development of mnemonic discrimination during childhood, the current study had 4-year-old children, 6-year-old children, and young adults complete the forced-choice Mnemonic Similarity Task (MST). The forced-choice MST offers a significant advantage in the context of developmental research because it is not sensitive to age-related differences in response criteria and includes three test formats that are theorized to be supported by different cognitive processes. A target (i.e., a previously encountered item) is paired with either a novel item (A-X), a corresponding lure (A-A'; i.e., an item mnemonically similar to the target), or a non-corresponding lure (A-B'; i.e., an item mnemonically similar to a different previously encoded item). We observed that 4-year-olds performed more poorly than 6-year-olds on the A-X and A-A' test formats, whereas both 4- and 6-year-olds performed more poorly than young adults on the A-B' test format. The MINERVA 2.2 computational model effectively accounted for these age-related differences. The model suggested that 4-year-olds have a lower learning rate (i.e., probability of encoding stimulus features) than 6-year-olds and young adults and that both 4- and 6-year-olds have greater encoding variability than young adults. These findings provide new insight into possible mechanisms underlying memory development during childhood and serve as the basis for multiple avenues of future research.

Commentary: The evidence base regarding the long-term effects of childhood mental disorder treatments needs to be strengthened - reply to Dekkers et al. (2023).

In their reply to our editorial (Journal of Child Psychology and Psychiatry, 2023, 64, 464), Dekkers et al. (Journal of Child Psychology and Psychiatry, 2023, 64, 470) argue that treatment is the best choice for children with mental disorders because there is 'sound evidence' that interventions are effective, also in the long term. We agree that there is sound evidence for treatment effectiveness in the short-term and there is some evidence for longer-term effects of certain specific treatments, such as behavioral parent training in children with behavioral disorders, as acknowledged in our editorial. However, we strongly disagree that there is sound evidence for long-term effectiveness.

A commentary on Perlstein et al. (2023): the past and future of treating youth with limited prosocial emotions.

Perlstein, Fair, Hong, and Waller (Journal of Child Psychology and Psychiatry, 2023) meta-analysis provides a critically important summary of the research on the treatment of children and adolescents with elevated callous-unemotional (CU) traits, 10 years after they were added to diagnostic criteria in the "with Limited Prosocial Emotions" specifier for conduct disorder. Their meta-analysis provides clear and convincing evidence that many treatments that reduce conduct problems in youth are also effective for children with elevated CU traits. However, their findings also indicate that CU traits are a severity indicator, in that youth high on these traits start treatment with more severe behavior problems and, despite improving with treatment, often leave treatment with more severe behavior problems. Such findings provide a clear focus for future research to adapt existing treatments to be more effective for youth with elevated CU traits. Further, the findings from the meta-analysis suggested that while treatments overall were not effective in reducing callous-unemotional traits, high-quality parenting interventions show promise for improving this outcome.

Commentary: Goldilocks Revisited: Do We Need More Practice Competencies in Pediatric Psychology?

The publication of the Thompson et al. competencies framework for pediatric palliative care marks a third set of practice guidelines published. There is essential tension between specialist training in clinical child psychology (our "home" discipline) leading to further subspecialty training in pediatric psychology, the desired balance between the two, and impact on teaching, training, and patient care. A purpose of this invited commentary is to stimulate further awareness and subsequent discussion of the integration of more narrow practice skills in a growing and developing field, as the tendency toward greater specialization and siloed practice increases.

Competencies for Psychology Practice in Pediatric Palliative Care.

OBJECTIVE: Pediatric psychologists have unique expertise to contribute to the care of youth with serious illnesses yet are not routinely integrated into pediatric palliative care (PPC) teams. To better define the role and unique skillset of psychologists practicing in PPC, support their systematic inclusion as part of PPC teams, and advance trainee knowledge of PPC principles and skills, the PPC Psychology Working Group sought to develop core competencies for psychologists in this subspecialty. METHODS: A Working Group of pediatric psychologists with expertise in PPC met monthly to review literature and existing competencies in pediatrics, pediatric and subspecialty psychology, adult palliative care, and PPC subspecialties. Using the modified competency cube framework, the Working Group drafted core competencies for PPC psychologists. Interdisciplinary review was conducted by a diverse group of PPC professionals and parent advocates, and competencies were revised accordingly. RESULTS: The six competency clusters include Science, Application, Education, Interpersonal, Professionalism, and Systems. Each cluster includes essential competencies (i.e., knowledge, skills, attitudes, roles) and behavioral anchors (i.e., examples of concrete application). Reviewer feedback highlighted clarity and thoroughness of competencies and suggested additional consideration of siblings and caregivers, spirituality, and psychologists' own positionality. CONCLUSIONS: Newly developed competencies for PPC psychologists highlight unique contributions to PPC patient care and research and provide a framework for highlighting psychology's value in this emerging subspecialty. Competencies help to advocate for inclusion of psychologists as routine members of PPC teams, standardize best practices among the PPC workforce, and provide optimal care for youth with serious illness and their families.

Acerca de lo virtual y sus implicancias para la vida psíquica / About virtuality and its implications for psychic life / Au sujet du virtuel et de ses consequences pour la vie psychique / Sobre a virtualidade e suas implicações na vida psicológica

¿A qué llamamos lo virtual? En camino a su mejor definición nos encontramos con los nuevos desarrollos conceptuales sobre el tema que dan cuenta de la trascendencia antropológica y subjetiva que va teniendo y cobrando cada vez mayor relevancia. Así pues, distintos teóricos ponen de relieve los cambios que se van produciendo a nivel psicológico y social, de lo que cabe referirnos en particular a la constitución psíquica en niñes y adolescentes. Podemos pensar al psicoanálisis como al juego en tanto espacios virtuales posibilitadores de una elaboración y una recreación subjetivas AU

What do we call the virtual? On the path to its best definition, we encounter new conceptual developments on the subject that account for its anthropological and subjective transcendence, which is increasingly gaining relevance. Different theorists highlight the changes that are occurring at the psychological and social levels, particularly in relation to the psychic constitution of children and adolescents. We can think of psychoanalysis as a game, as virtual spaces that enable subjective elaboration and recreation AU

Qu'appelle-t-on le virtuel? En cheminant vers sa meilleure définition nous trouvons les nouveaux développements conceptuels sur le sujet, qui rendent compte de la transcendance anthropologique et subjective qui devient chaque jour plus importante.Ainsi, différents théoriciens mettent en relief les changements qui se produisent au niveau psychologique et social, et nous nous référons ici tout particulièrement à la constitution psychique des enfants et des adolescents.Nous pouvons penser la psychanalyse ainsi que le jeu comme des espaces virtuels qui rendent possible une élaboration et une re création subjectives AU

O que chamamos de virtualidade? Em direção à sua melhor definição nos encontramos com novos desenvolvimentos conceituais sobre o tema que abrange a transcendência antropológica e subjetiva que vai adquirindo cada vez mais relevância. Assim, diferentes teóricos colocam em destaque as mudanças que são produzidas a nível psicológico e social, do qual podemos nos referir particularmente a constituição psicológica em crianças e adolescentes. Podemos pensar al psicoanálisis como a o jogo en tanto espacios virtuales posibilitadores de una elaboración y un re creación subjetivas. Podemos pensar na psicanálise como um jogo nos diversos espaços virtuais possibilitando uma elaboração e uma recriação subjetiva AU

Addressing Barriers to Career Development Awards for Early Career Women in Pediatric Psychology.

OBJECTIVE: To provide person and system-level recommendations for supporting early career women in the field of pediatric psychology in writing and submitting National Institutes of Health (NIH) Career Development Award (K award) applications. Recommendations are provided in the context of common barriers, with a focus on practical solutions. METHODS: Publicly available NIH reporter data were compiled to examine rates of funding for Society of Pediatric Psychology (SPP) members. Barriers that women face when initiating programs of research are described and applied to the field of pediatric psychology. RESULTS: Of current SPP members, 3.9% (n = 50) have ever received an NIH K award. Approximately 88.5% of SPP members identify as women, including 89.0% of SPP K award recipients. A table of person- and systems-level recommendations is provided to offer strategies for mentees, mentors/sponsors, institutions, and national organizations to address the barriers discussed. CONCLUSIONS: By addressing gender-specific barriers to submitting K award applications, we hope to increase the number of women K awardees and support the scientific advancement of pediatric psychology.

In the presence and absence of conflicting testimony, children's selective trust in the in-group informant in moral judgment and knowledge access.

In this study, we assessed whether the trust model formed by children in a moral judgment context with an inaccurate in-group informant affected their corresponding trust model in the knowledge access context and whether conditions (the presence of conflicting testimony: an inaccurate in-group informant paired with an accurate out-group informant; the absence of conflicting testimony: only an inaccurate in-group informant) influenced the trust model. Children aged 3 to 6 years (N = 215; 108 girls) in blue T-shirts as in-group members completed selective trust tasks in the moral judgment and knowledge access contexts. Results for moral judgment showed that children under both conditions were more likely to trust informants based on accurate judgments and gave less consideration to group identity. Results for knowledge access showed that in the presence of conflicting testimony, 3- and 4-year-olds trusted the in-group informant at chance, but 5- and 6-year-olds trusted the accurate informant. In the absence of conflicting testimony, 3- and 4-year-olds agreed more with the inaccurate in-group informant, but 5- and 6-year-olds trusted the in-group informant at chance. The results indicated that older children considered the accuracy of the informant's previous moral judgment for selective trust in the context of knowledge access while ignoring group identity, but that younger children were affected by in-group identity. The study found that 3- to 6-year-olds' trust in inaccurate in-group informants was conditional and that their trust choices appeared to be experimentally conditioned, domain specific, and age differentiated.

The Spanish Version of the Childhood Anxiety Sensitivity Index: Factorial Dimensions and Invariance across Gender in a Sample of Adolescents.

Anxiety sensitivity is a transdiagnostic construct that has been associated with the etiology of emotional disorders, especially panic and other anxiety disorders. Although it is well known that, for the adult population, the factor structure of anxiety sensitivity includes three separate facets (physical, cognitive, and social concerns), the facets of anxiety sensitivity for adolescents have not yet been established. The main goal of the present study was to examine the factor structure of the Spanish version of the Childhood Anxiety Sensitivity Index (CASI). A large sample of nonclinical adolescents completed the Spanish version of the CASI in school settings (N = 1655; aged 11-17 years; 800 boys and 855 girls). Exploratory and confirmatory factor analyses of the full scale (CASI-18) indicate that a three first-order factor solution represents appropriately the three anxiety sensitivity facets previously defined for the adult population. The 3-factor structure had a better fit and was more parsimonious than a 4-factor solution. Results also indicate that the 3-factor structure remains invariant across genders. Girls scored significantly higher than boys on the total scale and on all three dimensions of anxiety sensitivity. In addition, the present study provides information concerning normative data for the scale. The CASI holds promise as a useful tool for assessing general and specific facets of anxiety sensitivity. It could be helpful for the assessment of this construct in clinical and preventive settings. The limitations of the study and suggestions for further research are outlined.

Commonsense psychology in human infants and machines.

Human infants are fascinated by other people. They bring to this fascination a constellation of rich and flexible expectations about the intentions motivating people's actions. Here we test 11-month-old infants and state-of-the-art learning-driven neural-network models on the "Baby Intuitions Benchmark (BIB)," a suite of tasks challenging both infants and machines to make high-level predictions about the underlying causes of agents' actions. Infants expected agents' actions to be directed towards objects, not locations, and infants demonstrated default expectations about agents' rationally efficient actions towards goals. The neural-network models failed to capture infants' knowledge. Our work provides a comprehensive framework in which to characterize infants' commonsense psychology and takes the first step in testing whether human knowledge and human-like artificial intelligence can be built from the foundations cognitive and developmental theories postulate.

Negative impact of daily screen use on inhibitory control network in preadolescence: A two-year follow-up study.

The COVID-19 pandemic has made an unprecedented shift in children's daily lives. Children are increasingly spending time with screens to learn and connect with others. As the online environment rapidly substitutes in-person experience, understanding children's neuropsychological trajectories associated with screen experiences is important. Previous findings suggest that excessive screen use can lead children to prefer more immediate rewards over delayed outcomes. We hypothesized that increased screen time delays a child's development of inhibitory control system in the brain (i.e., fronto-striatal circuitry). By analyzing neuropsychological data from 8324 children (9-11ys) from the ABCD Study, we found that children who had more screen time showed a higher reward orientation and weaker fronto-striatal connectivity. Importantly, we found that the daily screen exposure mediated the effect of reward sensitivity on the development of the inhibitory control system in the brain over a two year period. These findings suggest possible negative long-term impacts of increased daily screen time on children's neuropsychological development. The results further demonstrated that screen time influences dorsal striatum connectivity, which suggests that the effect of daily screen use is a habitual seeking behavior. The study provides neural and behavioral evidence for the negative impact of daily screen use on developing children.

Beyond Clinical Care: The Role of Pediatric Psychology in Supporting Postpartum Depression Screening in Primary Care.

Maternal health is a critical component of optimal child health and development. Consequently, the American Academy of Pediatrics added postpartum depression (PPD) screening to their psychosocial screening guidelines in 2017. The Healthy Mothers, Healthy Children Project (HMHCP) was an interprofessional initiative aimed at preparing for, then implementing and maintaining pediatrician-completed PPD screening at 1-month well visits in a pediatric primary care clinic. Roles of pediatric psychology and rates of PPD screening were examined. Pediatric psychologists actively participated as leaders and collaborators in a variety of non-clinical roles from HMHCP preparation through maintenance. The clinic achieved high and continuously improving PPD screening rates following HMHCP implementation. Importantly, PPD screening rates were equitable across race and gender. The current study outlines feasible non-clinical roles that pediatric psychologists can fulfill in support of routine PPD screening within pediatric primary care. It also highlights associated benefits and outcomes for the clinic, providers, and patients.

Commentary: Advancing our understanding of the sleep-circadian pas de deux for adolescent psychopathology - a reflection on Cooper et al. (2023).

This is an exciting time for research in sleep and psychopathology during the period of adolescence. The study by Cooper et al. (Journal of Child Psychology and Psychiatry, 2023) is a much-welcome addition to a rapidly accumulating body of work, examining change in eveningness preference throughout adolescence and its prediction of internalizing and externalizing psychopathology. The study has a number of strengths, including a four-wave longitudinal design, multi-informant ratings of psychopathology, and an examination of white matter development in a subsample of participants. This commentary discusses the study's strengths and findings, while also providing directions for future research to build on the target article.