In an effort APA's Practice Directorate calls an important dialogue with pharmaceutical industry officials, the association recently held a day of consultation on psychological research with the Pharmacia Corporation to assist the company with plans to promote the proper diagnosis of growth hormone deficiency (GHD) in children and to help families deal with the psychosocial aspects of the disorder.
Pharmacia, one of the largest U.S. pharmaceutical companies, is developing an initiative to sponsor screening kits and educational workshops on healthy growth and GHD for pediatric nurses and other health professionals around the country.
GHD in children can result in very short stature. Since the mid-1980s, the production of synthetic growth hormone has made it possible to treat many more of these children with regular injections of the hormone.
Drawing attention to children's needs
Psychologist David Sandberg, PhD, one of the psychologist-experts who participated in the discussion with Pharmacia staff members, says the company's idea "is to identify children in primary care or in the school system who are showing signs of growth failure and to ensure that their comprehensive needs are met, both the medical and the psychological."
One fact the psychologists stressed was that growth failure can be a symptom of a variety of medical and psychological conditions, of which growth hormone deficiency is just one. That discussion, according to participants, helped prompt Pharmacia to broaden the initiative beyond GHD alone.
The psychologists also emphasized the mental health issues that sometimes occur in children with growth failure. When pediatricians suspect an underlying condition is causing a child's short stature, Sandberg says, they may refer the child to an endocrinologist, but they usually don't directly address to how the child is coping psychologically. These children can suffer from the social complications of being short, such as teasing, feeling inadequate and the assumptions by adults and children that they are younger than they are. And the hormone treatment itself can be stressful.
The psychologists also discussed the "hot buttons" pediatricians should look for in deciding whether children need mental health referrals, the obstacles to referral and methods to overcome them and tips for parents for managing the psychosocial issues.
The APA consultation also gave Pharmacia access to two psychology experts with very special knowledge of GHD: Stephen Ragusea, PsyD, attended with his son, Anthony Ragusea, who was helped to gain average height by the growth hormone treatment he took as a child.
Anthony Ragusea, now a first-year PsyD student at Wright State University in Dayton, Ohio, told the meeting how frightening some of the tests for the treatment are--including being put into insulin shock--and how awkward the treatment made him feel when he had to take syringes and medication on vacation.
He also acknowledged "thorny issues" including questions about whether most children receiving the treatment need it and the hazard of making shortness seem like a disease.
On the other hand, he notes that, as a child, "Shortness made me feel so different from everyone else that I think growing up without the treatment, I would have conformed my self concept to fit my stature, rather than developing it to fit my personality."
He argues, "Any treatment that enables me to be who I am is worth it to me."
Other psychologists at the meeting were Clarissa Holmes, PhD, of Virginia Commonwealth University and Doug Johnson-Greene, PhD, of Good Samaritan Hospital in Baltimore.
A project with potential
Although Pharmacia is still developing the campaign, possible future APA involvement could include assisting in the development of workshop curriculum and other materials, as well as encouraging psychologists to lead the workshop discussions on recognizing and managing psychological issues. Efforts might also be targeted at encouraging involvement of psychologists in treatment of children with growth disorders.
Sandberg, who has researched the psychological aspects of short stature for 10 years, calls the conversations--and particularly the potential for having pediatricians screen for mental health referral-- "an extraordinary opportunity to find an industry partner who is interested in helping us integrate care, medical and psychological," he says.
He notes that the effort could possibly serve as a model for screening all children in primary care for psychological issues that they might face.
The Practice Directorate notes that APA is proceeding cautiously in exploring potential relationships with pharmaceutical corporations. "Our interest is not in promoting the sale of pharmaceutical products," says APA Executive Director for Practice Russ Newman, PhD, JD. Instead, he says, the directorate's work with Pharmacia offers a great opportunity for psychology to influence a major initiative that potentially has substantial positive public benefit for health-care services to children.
"This collaborative project," says Newman "enables us to use psychological research and knowledge to support the healthy growth and development of our nation's youth."
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