Specialists in the field of developmental-behavioral pediatrics (DB peds) concern themselves with the evaluation, diagnosis and management of children failing to meet some expectation of typical development or who are at high risk for this problem. Children and adolescents challenged by their behavior form another group who present to the DB peds specialist.
Infants and toddlers are commonly seen because of risk related to prematurity or specific problems of feeding, sleep, elimination or developmental delay. Toddlers and preschool children are commonly seen because of delays in communication/socialization raising a concern for an autistic spectrum disorder. School-aged children and adolescents often present with problems in learning and/or attention. At all ages, children and adolescents with behavior issues, mood problems, or socialization difficulties may benefit from consultation and treatment. Parents often seek consultation with a DB peds specialist to receive an opinion about proposed interventions for their child or for diagnostic clarity when conflicting opinions exist.
In all cases, the child is seen in the context of the family. The developmental perspective considers all factors which may be conspiring to cause problems (genetic, environmental, psychological and physical). A significant effort is made to identify a child’s strengths and capitalize on these, minimizing challenges through safe, proven interventions.
Typical examples of patients cared for in the practice of DB peds are the following:
- A six month old infant born 3 months prematurely who fusses a lot and doesn’t sleep or eat well.
- An 18 month who is not talking yet and seems preoccupied with lining up his trucks, rather than playing with them.
- A 3rd grader with poor handwriting, short attention span, low grades and few friends.
- A teenager with suddenly failing grades.
- Parents of a child diagnosed with autism come in because they have been bombarded with advice about treatments and possible “cures”. They would like guidance in making the best decisions in choosing interventions most likely to benefit their child without harming her.
- Adolescents with worrisome changes in mood.
- Children of any age with pervasive anxiety, fears, sleep disturbance or obsessive-compulsive patterns of behavior.
Initial visits include detailed histories, structured family interviews, developmental testing and physical/neurological exams as indicated. In all cases, a careful synthesis of all factors potentially impacting the child, including psychosocial, is made to formulate a diagnostic impression. Further testing, such as genetic screening, imaging studies and neuropsychological/educational testing may be requested as part of this formulation. Recommendations for intervention may include psychological, educational, rehabilitative, nutritional or medical measures. Careful follow-up is the norm. Most initial evaluations take place over 2-6 hours with a typical visit lasting 60-90 minutes.
Diplomates in developmental-behavioral pediatrics have been certified as sub-specialists by the American Board of Pediatrics.
Frequently Asked Questions
- My child is on an IEP (individualized educational plan). I’m not sure it’s meeting his needs. Can you help me?
Yes. Specialists in DB peds are often asked to review interventions for children and provide input into plan development. We work in concert with educational advocates, teachers and other specialists to arrive at decisions in the best interest of the child. Occasionally, we are asked to attend meetings at schools regarding IEP’s.
- I’ve been told my son has attention deficit disorder (ADD) and that medication may help him. I’m worried about side effects and whether he’ll feel “drugged”. Can you help with this?
Yes. DB peds specialists are trained to implement and oversee medical treatments for these conditions. We are especially concerned with ensuring that the child/adolescent and their family agrees that any treatment undertaken is effective and beneficial to the child without bringing about disagreeable changes. DB peds specialists also look at ALL options for treatment to find what is best for a given child.
- Do you do IQ testing?
No. This kind of evaluation is done typically by clinical and educational psychologists.
- What kind of tests DO you do?
Evaluations done by DB peds specialists begin with a careful, structured and quite detailed interview. Questionnaires often provide further clarification. Standardized tests of developmental functions (language processing, motor, sensory, visual processing, memory, etc) are combined with assessments of emotional status, socialization and a complete physical and neurological examination. Other information, such as previous evaluations, blood tests, imaging studies, etc. is then considered as part of a diagnostic formulation that is then shared with the parents.