Topical Review: Building Competency: Professional Skills for Pediatric Psychologists in Integrated Primary Care Settings.

OBJECTIVES : In the midst of large-scale changes across our nation's health care system, including the Affordable Care Act and Patient-Centered Medical Home initiatives, integrated primary care models afford important opportunities for those in the field of pediatric psychology. Despite the extensive and growing attention, this subspecialty has received in recent years, a comprehensive set of core professional competencies has not been established. METHODS : A subset of an Integrated Primary Care Special Interest Group used two well-established sets of core competencies in integrated primary care and pediatric psychology as a basis to develop a set of integrated pediatric primary care-specific behavioral anchors. CONCLUSIONS : The current manuscript describes these behavioral anchors and their development in the context of professional training as well as with regard to Triple Aim goals and securing psychology's role in integrated pediatric primary care settings.

Predicting cardiac vagal regulation in early childhood from maternal-child relationship quality during toddlerhood.

The aim of this study was to examine the influence of maternal-child relationship quality during toddlerhood on early childhood physiological regulation. A community sample of 447 children (215 males) was recruited at age 2 for participation in the study using the Child Behavior Checklist [Achenbach [1992] Manual for the child behavior checklist/2-3 & 1992 profile. Burlington, VT: University of VT Department of Psychiatry]. Mothers and children were observed across several interactions in the laboratory at age 2 and mothers completed the Parenting Stress Index [Abidin [1995] Manual for the parenting stress index. Odessa, FL: Psychological Assessment Resources]. Relationship quality was assessed using laboratory measures of hostility, positive guidance, and stress related to the quality of the relationship as reported by mothers. Cardiac vagal regulation at age 2 was assessed across six challenge tasks, three in which the child and mother worked together and three in which the child worked independently, and was indexed by the magnitude of vagal withdrawal (decrease in respiratory sinus arrhythmia, RSA) to challenge. Results indicated that children displayed greater cardiac vagal regulation and heart rate acceleration during collaborative tasks versus independent tasks. In addition, maternal-child relationship quality predicted the degree of vagal regulation in children at age 5, even after controlling for early and concurrent level of behavior problems as well as 2-year cardiac vagal regulation. Children with poorer quality relationships displayed significantly poorer vagal regulation and lower heart rate acceleration (p < .01). These findings are discussed in terms of the implications of environmental factors for the acquisition of fundamental self-regulatory skills.

Temperament and externalizing behavior: social preference and perceived acceptance as protective factors.

The purpose of this study was to explore the role of social preference and perceived acceptance as moderators of the relation between child temperament and externalizing behavior. Participants included 399 children evaluated at pre-kindergarten and kindergarten assessments. Pre-kindergarten children characterized by high temperamental Surgency/Extraversion were more likely to exhibit hyperactivity and aggression in the kindergarten classroom. In addition, kindergarten perceived acceptance and social preference moderated the relation between pre-kindergarten Surgency/Extraversion and kindergarten hyperactivity for girls only. Girls who were characterized by high temperamental Surgency/Extraversion, high perceived acceptance, and low social preference were at risk for higher levels of teacher-reported and peer-nominated hyperactivity. In contrast, accurately high perceived acceptance was a protective factor for high temperamental Surgency/Extraversion. Findings are discussed in terms of risk and protective factors for externalizing behavior.