pediatric health concern, with estimates on nonadherence as high as 50% or higher. children's adherence to their medical regimens is heavily influenced by developmental, as well as family factors. medical management of chronic and serious pediatric illness often requires stressful role relationship changes within the family that require redistribution of time and redefinition of responsibilities. the impact of these changes can be far reaching, affecting such factors as marital satisfaction and parent adjustment. nonadherance to prescribed medical regimens can be the result of variety of factors including lack of education and training in the regimen, difficulty in understanding the procedures, fearfulness and anxiety, interference of the treatment with normal activities, and parent or child dynamics, among others. nonadherence or poor adherence to medical regimens may adversely affect the health of the pediatric patient, resulting in hospitalization to address disease processes and adherence issues. nonadherence issues include failure to administer medications as prescribed, failure to follow dietary guidelines, defiance of physical activity restrictions, and uncooperativeness with medical procedures. several methods might be employed the help patients and their families monitor adherence, including direct observations of the patient's behavior; assays of blood, urine, or saliva; self-report, health care provider ratings, pill counts, and a variety of monitoring devices, for example, blood glucose meters. interventions that can be sued to facilitate patient and family adherence in the inpatient pediatric setting include providing information and education, teaching mastery skills, behavioral management contracting, removing barriers, monitoring and charting performance of medical treatment components, addressing family or health care system dynamics, normalizing or reframing the patient's condition, altering patient or family lifestyle behaviors, altering expectations of family or health care providers to coincide with realistic developmental needs, negotiation and compromise. communication pediatric consultation-liaison psychologists often deal with situations wherein medical staff members have made a referral due to behavioral difficulties with the child or their family that are disruptive to the functioning of the hospital unit. often overwhelmed, bewildered, and at the point of significant frustration and defensiveness, the patient and their family are frequently unaware of the referral, which places the consultant in a potentially volatile situation. strong diplomatic and communication skills, as well as sensitivity to patient, family, and hospital staff issues, are required in such situations by arranging and coordinating staffings on difficult and complex cases, maintaining a regular presence at service rounds and team meetings, fostering ongoing collaborative relationships with hospital staff, promoting ever increasing cultural sensitivity, and respectfully listening to and reframing patient or family and staff behaviors to facilitate understanding across all parties involved, the pediatric consultation-liaison psychologist can do much to defuse potentially volatile situations. collaboration carter and von weiss suggest that while collaboration is listed one of the five c's, it cannot be emphasized enough because it underlies the potential successfulness of practice in the other four. the relationship between the pediatric psychologist and the referring services has evolved out of shared goals in the areas of research, teaching, and service. close collaborative relationships have the potential of having a critical impact on the clinical care of patients and their families. diversity special interest group the diversity special interest group is committed to promoting diversity in pediatric psychology research and clinical care, to increasing the number of society of pediatric psychology members from diverse backgrounds, and to providing services and resources for members who are from underrepresented groups. epilepsy special interest group the epilepsy special interest group's goals are to increase awareness of epilepsy among society of pediatric psychology members, foster communication between and support for pediatric psychologists, and liaison with the american epilepsy society. obesity special interest group the obesity special interest group provides education, training and mentoring of psychologists in the care of overweight/obese youth and advocacy for public policy. pediatric bioethics special interest group the pediatric bioethics special interest group provides a forum to discuss challenges, share ideas and resources, and pursue collaborative relationships with a community of other pediatric psychologists. pediatric cardiology special interest group the pediatric cardiology special interest group promotes the discussion of issues faced by pediatric psychologists who work with children who have congenital heart disease, cardiac transplant, or other cardiac conditions. pediatric gastroenterology special interest group the mission of this pediatric gastroenterology special interest group is to facilitate the study and discussion of psychosocial aspects of pediatric gastroenterological conditions; develop collaborative relationships among practitioners who carry out psychological interventions with pediatric gi populations, and educate clinical professionals about the psychosocial issues which may affect the child or adolescent with a gastroenterological condition. pediatric pain special interest group pediatric pain is a common condition of childhood/adolescence. as such, many pediatric psychologists research and provide clinical care in this area and specialized programs are developing. the pediatric pain special interest group provides a forum for communication and discussion about the many developments in the field. modern training the road to becoming a pediatric psychologist is long and consists of many years of training. most clinicians have a strong background in psychology coming out of their undergraduate schooling. it is ideal for prospective students to take courses in developmental psychology, health psychology, developmental psychopathology, abnormal psychology, and many others. in order to be competitive when applying to graduate schools, most students will have a strong background in research either as an assistant in a pediatric psychology lab, conducting independent studies, or both. student's may also find it beneficial to acquire field experience with children in order to demonstrate that they can become adept clinicians. in addition to this, for admission to graduate school, it is necessary to have a relationship with three or more psychologists in order to provide letters of recommendation. to become a full-fledged pediatric psychologist one must obtain a doctoral degree in the form of either a ph.d. or psy.d. in clinical or counseling psychology. graduate training typically requires 4–5 years of graduate school and an additional year spent on an internship. some programs will require the completion of a master's thesis while others will not. all, however, will require that students complete a dissertation consisting of original research. a doctoral program will use the scientist practitioner or boulder model which emphasizes training in both clinical practice and research methodology, while a psyd program will likely use the vail model which emphasizes clinical skills much more than research. some schools will provide a specialization in child clinical psychology or health psychology which can supplement normal training with a pediatric twist. another aspect of graduate training is external practicums in settings such hospitals or clinics. gaining experience working in these areas is essential in order to be prepared to obtain a job after graduate school. in order to help standardize the training each psychologist receives, the society of pediatric psychology task force developed a list of 12 training areas necessary for a specialty in pediatric psychology: lifespan development lifespan developmental psychopathology child, adolescent, and family assessment intervention strategies research methods and systems evaluation professional, ethical, and legal issues pertaining to children, adolescents, and families diversity issues and multicultural competence role of multiple disciplines in service delivery systems prevention, family support, and health promotion social issues affecting children, adolescents, and families consultation-liaison (cl) roles disease process and medical management after graduate school, there are many choices in order to determine the field best suited to one's interests. some individuals will engage in a fellowship which will allow for increased knowledge in specific areas of clinical psychology and research and may yield more job opportunities. a postdoctoral fellowship may also provide supervised clinical hours which are required in order to become independently licensed in a state. finally, some pediatric psychologists will go on to engage in clinical practice while others will not. in order to practice as a clinical psychologist one must obtain a doctoral degree from an approved program, complete a required amount of supervised clinical hours, pass the examination for professional practice in psychology (eppp), and be knowledgeable of all state regulations. pediatric psychologists may choose to become certified by the american board of professional psychology (abpp) and can apply for advanced credentials through the american board of clinical child and adolescent psychology (abccap) or the american board of clinical health psychology (abchp). research the main goal of pediatric research is to understand child development occurring with health-related issues. using ecological systems framework, pediatric psychologists discover the ways in which health issues might affect children and their families and ways to promote physical health and psychological adjustment in pediatric-health populations. important issues currently addressed in pediatric psychology research across various diagnoses include: cultural and diversity issues evidence-based practice inpatient pediatric consultation-liaison adherence to treatment regimens chronic and recurrent pain management of pain and distress due to medical procedures pharmacology and psychopharmacology medical traumatic stress palliative care, end of life, bereavement ehealth application pediatric psycho-oncology common research areas in pediatric psychology neonatology, prematurity, and developmental issues pediatric asthma cystic fibrosis diabetes mellitus sickle-cell disease pediatric oncology traumatic brain injury and spinal cord injury central nervous system disorders (e.g., epilepsy, spina bifida) juvenile idiopathic arthritis cardiovascular disease pediatric organ transplantation abdominal pain-related gastrointestinal disorders (e.g., irritable bowel syndrome, inflammatory bowel disease) pediatric hiv/aids pediatric burns feeding and vomiting problems childhood obesity eating disorders elimination disorders (e.g., enuresis, encopresis) pediatric sleep autism spectrum disorders and developmental disabilities behavior problems in a pediatric context attention deficit hyperactivity disorder in the pediatric context child abuse injuries and safety: unintentional injuries are the leading cause of disability and death in children and teens from the age of 1 to 19 years. more children and adolescents die as a result of an unintentional injury than from all other childhood diseases combined. health care providers have multiple opportunities to provide prevention materials and injury guidance. simon et al. (2006) found that less frequent injury guidance results in more frequent medically linked injuries by 16 months of age. research suggests that counseling increases parental safety behaviors and counseling tailored to risk behaviors of a particular family are most effective. pediatric psychology has a significant role to play in formulating, implementing, and evaluating injury prevention efforts. future research directions positive, resilience factors, and quality of life: pediatric psychologists are increasingly understanding and applying research on resilience factors and protective factors. researchers have discovered that despite psychological risk factors associated with childhood chronic illnesses, the majority of children with chronic illnesses fare just as well as their peers or even better in some cases. furthermore, the study of health-related quality of life (hrqol) is unique to the pediatric setting and encompasses domains of physical, psychological, and social functioning that are directly influenced by chronic illnesses. researchers have found that pediatric cancer survivors typically report positive outcomes, while lower levels were reported in children and teens with diabetes, cystic fibrosis, and asthma, which may be due in part to the intensity and duration of the treatments. researchers' current goal is to identify areas of functioning that are relatively untouched from the illness and treatment and to focus in on the domains of the hrqol for which there is an increased risk so that prevention and intervention efforts can target the most valuable domains.