Front Cover 1
Developmental-Behavioral Pediatrics: Evidence and Practice 4
Copyright Page 5
Contributors 6
Introduction 14
Contents 18
CHAPTER 1.The History of Child Developmental- Behavioral Health Policy in the United States 20
DEVELOPMENT AS STATE INTEREST 21
DEVELOPMENT AS CASUALTY 22
DEVELOPMENT AS JUSTICE 23
DEVELOPMENT AS IDENTITY 26
SUMMARY 27
DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS TIMELINE 28
CHAPTER 2. Theoretical Foundations of Developmental-Behavioral Pediatrics 32
WHAT MAKES A GOOD THEORY? 33
THEORETICAL MODELS IN DEVELOPMENTAL-BEHAVIORAL PEDIATRICS 39
CONCLUSIONS AND FUTURE DIRECTIONS 57
CHAPTER 3. Research Foundations, Methods, and Issues in Developmental- Behavioral Pediatrics 66
THE UNIQUE NATURE OF DEVELOPMENTAL-BEHAVIORAL PEDIATRIC RESEARCH 66
CROSS-CUTTING METHODOLOGICAL AND THEORETICAL ISSUES 67
ETHICAL ISSUES 70
IMPLICATIONS FOR RESEARCH TRAINING IN DEVELOPMENTAL-BEHAVIORAL PEDIATRICS 71
SUMMARY 74
CHAPTER 4. The Origins of Behavior and Cognition in the Developing Brain* 76
GENE-DRIVEN PROCESSES 76
TISSUE INDUCTION AND FORMING THE BASIC BRAIN PATTERN 77
HISTOGENESIS, MIGRATION, AND CELL FATE 78
NEURAL PATHWAYS AND SYNAPTIC CONNECTIONS 80
EXPERIENCE-EXPECTANT DEVELOPMENT 81
EXPERIENCE-DEPENDENT DEVELOPMENT 85
EVIDENCE FOR HUMAN NEURAL PLASTICITY 88
CLINICAL APPLICATIONS 89
CHAPTER 5. Family Context in Developmental-Behavioral Pediatrics 98
SOCIAL-ECOLOGICAL MODEL 100
FAMILIES AS ORGANIZED SYSTEMS 104
CULTURAL VARIATIONS IN FAMILY CONTEXT 112
FAMILY-BASED INTERVENTIONS 116
FAMILY ASSESSMENT 119
FUTURE DIRECTIONS IN FAMILY RESEARCH AND INTERVENTIONS 121
CHILD AND FAMILY HEALTH: POLICY PRIORITIES 121
CHAPTER 6. Diagnostic Classification Systems 128
CHALLENGES OF DIAGNOSIS IN DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS 128
SYSTEMS FOR DIAGNOSTIC CLASSIFICATION OF DEVELOPMENTAL AND BEHAVIOR PROBLEMS 128
FUTURE RESEARCH DIRECTIONS IN CLASSIFICATION SYSTEMS 140
CHAPTER 7. Screening and Assessment Tools 142
7A. Measurement and Psychometric Considerations 142
STANDARDIZED ASSESSMENTS 143
PRIMER OF TERMINOLOGY USED TO DETECT DYSFUNCTION 144
PSYCHOMETRIC CONCERNS 145
7B. Surveillance and Screening for Development and Behavior 149
BACKGROUND 150
DEVELOPMENTAL SURVEILLANCE 151
USE OF SCREENING TOOLS 152
COMBINING SCREENING AND SURVEILLANCE 158
SYSTEMWIDE APPROACHES TO SURVEILLANCE AND SCREENING 159
CONCLUSION 162
DIRECTIONS FOR FURTHER RESEARCH 162
7C. Assessment of Development and Behavior 163
CASE ILLUSTRATIONS 164
\ 166
INTERVIEWS 166
TESTING METHODS: DEVELOPMENTAL AND COGNITIVE 168
TESTING METHODS: BEHAVIORAL AND EMOTIONAL 177
SUMMARY AND IMPLICATIONS FOR CLINICAL CARE 190
SUMMARY AND IMPLICATIONS FOR RESEARCH 191
7D. Assessment of Language and Speech 196
BASIC DEFINITIONS 196
TYPICAL LANGUAGE DEVELOPMENT 198
INDIVIDUAL VARIATIONS IN SPEECH AND LANGUAGE DEVELOPMENT 202
ASSESSMENTS 202
CONCLUSIONS AND EMERGING ISSUES 208
7E. Assessment of Motor Skills 209
FOCUS OF MOTOR SKILLS ASSESSMENT 210
PURPOSES OF MOTOR ASSESSMENT 212
GENERAL CONSIDERATIONS FOR ASSESSMENT OF MOTOR SKILLS 214
MOTOR ASSESSMENT OF INFANTS AND TODDLERS 214
MOTOR ASSESSMENT OF PRESCHOOL-AGED CHILDREN 215
MOTOR ASSESSMENT OF SCHOOL-AGED CHILDREN 217
MOTOR ASSESSMENT OF ADOLESCENTS 218
RECOMMENDATIONS FOR THE FUTURE 218
CHAPTER 8. Treatment and Management 222
8A. The Interdisciplinary Team Approach 222
HISTORY 222
HISTORY WITH REGARD TO CHILDREN WITH DEVELOPMENTAL DISABILITIES 224
WHAT IS A TEAM? 225
MODELS OF TEAMWORK 226
FACTORS THAT CONTRIBUTE TO INTERDISCIPLINARY TEAM COLLABORATION 228
FACTORS THAT PRESENT CHALLENGES FOR INTERDISCIPLINARY TEAM COLLABORATION 229
CONCEPTUAL MODELS USED TO EVALUATE INTERDISCIPLINARY TEAMS 230
REVIEW OF THE RESEARCH ON INTERDISCIPLINARY TEAMS 230
8B. Family-Centered Care and the Medical Home 233
HISTORICAL FOUNDATIONS OF THE FAMILY-CENTERED CARE CONCEPT 233
SELECTED RESEARCH EVIDENCE REGARDING FAMILY-CENTERED CARE 236
THE MEDICAL HOME 239
CONCLUSION 242
8C. Psychopharmacological Management of Disorders of Development and Behavior 244
GENERAL PRINCIPLES OF PSYCHOTROPIC MEDICATION USE IN CHILDREN AND ADOLESCENTS 244
MEDICATIONS FOR ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER 245
ANTIDEPRESSANTS 248
ANTIPSYCHOTICS 251
MOOD STABILIZERS 253
ANXIOLYTICS 255
RATIONAL POLYPHARMACY 255
NONSTANDARD AND ALTERNATIVE THERAPIES 256
FUTURE DIRECTIONS 256
8D. Evidence-Based Psychological Interventions for Emotional and Behavioral Disorders 259
OVERVIEW OF PSYCHOLOGICAL INTERVENTION LITERATURE 260
PSYCHOLOGICAL MANAGEMENT OF DEPRESSION 261
PSYCHOLOGICAL MANAGEMENT OF ANXIETY AND FEARS 263
PSYCHOLOGICAL MANAGEMENT OF INATTENTION, IMPULSIVITY, AND HYPERACTIVITY 266
PSYCHOLOGICAL MANAGEMENT OF CONDUCT PROBLEMS 268
FINAL THOUGHTS AND RECOMMENDATIONS 272
8E. Complementary and Alternative Medicine in Developmental-Behavioral Pediatrics 278
EPIDEMIOLOGY OF COMPLEMENTARY AND ALTERNATIVE MEDICINE USE 278
WHAT IS CAM? 279
THE FIVE DOMAINS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE 281
WORKING WITH FAMILIES INTERESTED IN COMPLEMENTARY AND ALTERNATIVE MEDICINE 293
CONCLUSION 295
CHAPTER 9. Adaptation to General Health Problems and Their Treatment 300
CHILDREN\u2019S UNDERSTANDING OF HEALTH AND ILLNESS 300
SICK CHILDREN\u2019S UNDERSTANDING OF ILLNESS 302
CHILDREN\u2019S ADAPTATION TO STRESS 305
CHILDREN\u2019S UNDERSTANDING OF DEATH 306
CHRONIC ILLNESS AS A PARADIGM OF STRESS 309
THE COMPETENCY OF MINORS TO MAKE MEDICAL DECISIONS 313
TRANSITION TO ADULT CARE 314
CHAPTER 10. Developmental-Behavioral Aspects of Chronic Conditions 320
10A. Effects of Adverse Natal Factors and Prematurity 320
HISTORICAL OVERVIEW 320
FOLLOW-UP STUDIES OF INFANTS WITH VERY LOW BIRTH WEIGHT 321
IMPLICATIONS FOR CLINICAL ASSESSMENT, MONITORING, AND CHILD HEALTH SUPERVISION 329
CONCLUSIONS 330
10B. Genetics in Developmental- Behavioral Pediatrics 336
MECHANISMS OF GENETIC DISORDERS AND DIFFERENCES 336
PHENOTYPES 341
INTERACTION OF GENETICS AND ENVIRONMENT 344
GENETIC DIAGNOSIS 346
COMPENDIUM OF DEVELOPMENTAL-BEHAVIORAL PHENOTYPES 349
CONCLUSION 353
10C. Metabolic Disorders 355
TYPES OF INBORN ERRORS OF METABOLISM THAT AFFECT DEVELOPMENT 356
TIMING OF DEVELOPMENTAL DELAY AND METABOLIC CONSIDERATIONS 357
CLUES IN THE HISTORY THAT SUGGEST A METABOLIC DISEASE IN THE DEVLOPMENTALLY DELAYED PATIENT 357
CLUES IN THE PHYSICAL EXAMINATION THAT ARE SUGGESTIVE OF A METABOLIC DISEASE IN THE DEVELOPMENTALLY DELAYED PATIENT 359
LABORATORY TESTS FOR THE WORKUP OF METABOLIC DISEASE IN DEVELOPMENTAL DELAY 359
APPROACH TO DIAGNOSING METABOLIC DISEASE IN A PATIENT WITH DEVELOPMENTAL PATHOLOGY 362
SUMMARY 363
10D. Developmental and Behavioral Outcomes of Infectious Diseases 364
INFECTIONS OF THE NEONATE AND INFANT 365
INFECTIONS OF CHILDREN AND ADOLESCENTS 371
OTHER, LESS COMMON INFECTIONS ASSOCIATED WITH BEHAVIORAL SYMPTOMS 371
HUMAN IMMUNODEFICIENCY VIRUS 372
THE VULNERABLE CHILD SYNDROME 375
10E. Central Nervous System Disorders 378
THE NEUROLOGICAL EVALUATION 378
EPILEPSY 381
HYDROCEPHALUS 386
STROKE 388
TRAUMATIC BRAIN INJURY 390
TUMORS OF THE CENTRAL NERVOUS SYSTEM 394
NEUROCUTANEOUS DISORDERS 396
CONCLUSION 398
REFERENCES 398
10F. Sensory Deficits 402
THE SENSORY SYSTEMS 402
HEARING IMPAIRMENT 403
VISUAL IMPAIRMENT 411
OTHER SENSORY DEVIATIONS 417
SENSORY INTEGRATION 418
CHAPTER 11. Cognitive and Adaptive Disabilities 424
PURPOSE 424
TERMINOLOGY DEBATE 424
DEFINITION AND CRITERIA 425
ETIOLOGY 427
CLINICAL MANAGEMENT 431
CLINICAL DIAGNOSIS 433
MANAGEMENT 437
DEVELOPMENTAL, EDUCATIONAL, AND VOCATIONAL SERVICES 447
COMMUNITY AND PUBLIC SUPPORTS 451
ADULT OUTCOME 456
FUTURE RESEARCH 456
CONCLUSIONS 457
CHAPTER 12. Learning Disabilities 464
HISTORICAL OVERVIEW 464
DIAGNOSTIC AND DEFINITIONAL ISSUES 465
CORE COGNITIVE CORRELATES AND NEUROBIOLOGICAL FACTORS 467
PREVENTION AND INTERVENTION 471
LONG-TERM OUTCOMES 475
THE ROLE OF THE DEVELOPMENTAL-BEHAVIORAL PEDIATRICIAN IN THE CLINICAL MANAGEMENT OF LEARNING DISABILITY 476
CONCLUSION 479
CHAPTER 13. Language and Speech Disorders 486
DEVELOPMENTAL DELAYS IN LANGUAGE AND SPEECH 486
LANGUAGE DISORDERS 488
SPEECH SOUND DISORDERS 495
CONCLUSION 499
CHAPTER 14. Motor Disabilities and Multiple Handicapping Conditions 502
CEREBRAL PALSY 502
SPINA BIFIDA 513
CHAPTER 15. Autism Spectrum Disorders 538
TERMINOLOGY 539
HISTORY 541
PREVALENCE 541
ETIOLOGY 542
NEUROLOGICAL CORRELATES 546
CLINICAL SIGNS 549
IDENTIFICATION AND DIAGNOSIS 554
MANAGEMENT 566
PROGNOSIS 577
FUTURE DIRECTIONS 578
FAMILY RESOURCES 579
CHAPTER 16. Attention-Deficit/Hyperactivity Disorder 598
HISTORY 598
PREVALENCE 599
ETIOLOGY 600
PROGNOSIS 600
EVALUATION AND DIAGNOSIS 600
TREATMENT 604
CHAPTER 17. Externalizing Conditions 622
NORMAL VARIATIONS IN EXTERNALIZING BEHAVIORS AND RELATED EMOTIONAL CHARACTERISTICS 622
ETIOLOGY: RISK AND CAUSAL FACTORS WITHIN A CONTEXTUAL SOCIAL-COGNITIVE MODEL 625
ASSESSMENT OF EXTERNALIZING BEHAVIOR PROBLEMS 629
TREATMENT OF EXTERNALIZING CONDITIONS 632
RESEARCH IMPLICATIONS AND SUMMARY 640
CHAPTER 18. Internalizing Conditions 646
18A. Mood Disorders 646
SIGNIFICANCE 646
CAUSES 647
DIAGNOSIS 649
ASSESSMENT 652
ASSOCIATED CONDITIONS 655
TREATMENT 655
PREVENTION 658
CLINICAL IMPLICATIONS 659
RESEARCH IMPLICATIONS 659
18B. Anxiety Disorders 664
OVERVIEW 665
ASSESSMENT METHODS 668
SPECIFIC ANXIETY DISORDERS 670
COLLABORATIVE CARE PRACTICES 678
FUTURE DIRECTIONS 680
CHAPTER 19. The Effect of Substance Use Disorders on Children and Adolescents 688
INCIDENCE AND PREVALENCE 688
TOBACCO 689
ALCOHOL 689
INHALANTS 691
COCAINE 692
AMPHETAMINES 692
OPIATES 692
CLUB DRUGS 693
MDMA 693
FAMILY EFFECTS OF ALCOHOL AND OTHER DRUG USE 695
EARLY IDENTIFICATION OF SUBSTANCE USE DISORDERS 696
INTERVIEWING CHILDREN, YOUTH, AND FAMILIES 698
A DEVELOPMENTAL LIFESPAN PERSPECTIVE ON SCREENING 699
APPROACHES TO SCREENING 701
EARLY INTERVENTION FOR SUBSTANCE USE DISORDERS 703
HEALTH AND NEURODEVELOPMENTAL OUTCOME STUDIES OF CHILDREN WITH INTRAUTERINE DRUG EXPOSURE 704
PREVENTION AND TREATMENT 710
CHAPTER 20. Child Maltreatment: Developmental Consequences 718
REPORTING, CLINICAL ASSESSMENT, AND TREATMENT OF THE MALTREATED CHILD 719
NEUROLOGICAL CONSEQUENCES OF NONACCIDENTAL TRAUMA 720
EFFECTS OF CHILD MALTREATMENT 721
EFFECTS ON ADULTS 724
IMPLICATIONS FOR CHILDREN WITH DISABILITIES 724
CHAPTER 21. Pain and Somatoform Disorders 730
DEFINITIONS OF PAIN AND SOMATOFORM DISORDERS 730
CLINICAL AND SCIENTIFIC SIGNIFICANCE OF PAIN AND SOMATOFORM DISORDERS 731
CAUSES 734
DIAGNOSIS/ASSESSMENT 737
TREATMENT STRATEGIES FOR PAIN AND SOMATOFORM DISORDERS 746
SUMMARY AND IMPLICATIONS 754
CHAPTER 22. Sleep and Sleep Disorders in Children 762
NORMAL SLEEP IN INFANTS, CHILDREN, AND ADOLESCENTS 762
NEUROBEHAVIORAL AND NEUROCOGNITIVE EFFECT OF INADEQUATE AND DISRUPTED SLEEP IN CHILDREN 764
COMMON SLEEP DISORDERS IN CHILDREN: ETIOLOGY, EPIDEMIOLOGY, PRESENTATION, EVALUATION, AND TREATMENT 765
SLEEP ISSUES IN SPECIAL POPULATIONS 769
IMPLICATIONS FOR CLINICAL CARE AND RESEARCH 771
CHAPTER 23. Feeding and Eating Conditions 776
23A. Introduction 776
23B. Infant Feeding Processes and Disorders 776
FEEDING DEVELOPMENT 776
FEEDING CONCERNS, DISTURBANCES, AND DISORDERS 780
SPECIFIC INFANT FEEDING DISORDERS 782
SIGNIFICANCE AND IMPLICATIONS 785
23C. Food Insecurity and Failure to Thrive 787
EPIDEMIOLOGY AND CLINICAL SIGNIFICANCE 787
ETIOLOGY 787
DIAGNOSIS 788
ASSESSMENT 789
MANAGEMENT 793
REFERENCES 796
23D. Obesity and Restrictive Eating Disorders 798
OBESITY 798
RESTRICTIVE EATING DISORDERS 802
A DEVELOPMENTAL PERSPECTIVE 804
SUMMARY 805
CHAPTER 24. Elimination Conditions 810
TOILET TRAINING AS A DEVELOPMENTAL MILESTONE 810
LOSS OF CONTINENCE CAN SIGNAL MEDICAL OR EMOTIONAL PATHOLOGY 810
TREATMENT OFTEN INCLUDES MEDICAL AND BEHAVIORAL INTERVENTION 811
TOILET TRAINING 811
ENCOPRESIS 813
ENURESIS 817
SUMMARY OF CLINICAL CARE 822
CHAPTER 25. Sexuality 824
25A. Sexual Development and Sexual Behavior Problems 824
TERMINOLOGY 824
SEXUAL DEVELOPMENT 825
SPECIAL TOPICS ON SEXUAL DEVELOPMENT: CULTURAL FACTORS, SEXUAL ORIENTATION, DEVELOPMENTAL DISABILITIES, AND SEXUAL ABUSE 829
SEXUAL BEHAVIOR PROBLEMS 830
RECOMMENDATIONS CONCERNING CLINICAL CARE 834
OTHER RELEVANT TOPICS 836
FUTURE DIRECTIONS 837
SUMMARY 839
25B. Gender Identity 844
CLINICAL AND SCIENTIFIC SIGNIFICANCE 844
TERMINOLOGY 845
PREVALENCE 845
SEX DIFFERENCES IN REFERRAL RATES 845
DIAGNOSIS AND ASSESSMENT 846
DEVELOPMENTAL TRAJECTORIES 847
DISJUNCTIONS BETWEEN RETROSPECTIVE AND PROSPECTIVE DATA 849
ETIOLOGY 849
THERAPEUTICS 851
FUTURE DIRECTIONS 855
25C. Variations in Sexual Orientation and Sexual Expression 858
EXPLANATIONS FOR VARIATIONS IN SEXUAL ORIENTATION 858
DEVELOPMENT OF A GAY OR LESBIAN IDENTITY 860
TRANSGENDER YOUTH 871
CHILDREN WHOSE PARENTS ARE GAY OR LESBIAN 871
OPPORTUNITIES AND RESPONSIBILITIES OF HEALTH CARE PROVIDERS 877
SUMMARY 881
CHAPTER 26. Atypical Behavior:Self-Injury and Pica 890
SELF-INJURIOUS BEHAVIOR 890
PICA 899
SUMMARY 901
CHAPTER 27. Strategies to Enhance Developmental and Behavioral Services in Primary Care 906
WHY CHANGE AT THIS TIME? 906
HISTORICAL PERSPECTIVE 907
WELL-CHILD VISITS: WHAT DO WE DO THAT IS EVIDENCE-BASED? 908
CLINICAL INTERVIEW AND THERAPEUTIC RELATIONSHIP 908
SCREENING FOR DEVELOPMENTAL AND BEHAVIORAL CONDITIONS WITH CHECKLISTS AND QUESTIONNAIRES 910
INNOVATIONS TO ENHANCE QUALITY AND BREADTH OF ATTENTION TO DEVELOPMENT AND BEHAVIOR IN OFFICE PRACTICE 911
COMMUNITY-BASED NEEDS ASSESSMENT 915
COORDINATION OF CARE AND LINKAGES WITH COMMUNITY RESOURCES 916
FAMILY DRAWINGS: AN OPPORTUNITY FOR ENHANCED COMMUNICATION WITH PARENTS AND CHILDREN 916
DEVELOPMENTAL AND BEHAVIORAL PEDIATRIC TRAINING FOR PEDIATRIC RESIDENTS 917
RETHINKING WELL-CHILD CARE 919
SUMMARY: ESSENTIAL COMPONENTS OF \u201cTHINKING DEVELOPMENTALLY\u201d DURING PRIMARY CARE OFFICE PEDIATRIC ENCOUNTERS 920
CHAPTER 28. Ethical Issues in Developmental- Behavioral Pediatrics: A Historical Approach 924
OVERVIEW OF TRADITIONAL BIOETHICS 924
END-OF-LIFE DECISIONS AND THE HISTORY OF PERSONS WITH DEVELOPMENTAL DISABILITIES 928
GENETICS, SURGICAL SHAPING, AND ASSUMPTIONS ABOUT DISABILITY 935
SCIENCE, PRACTICE, AND ADVOCACY 938
Appendix 944
CHAPTER 6 944
CHAPTER 8B 947
CHAPTER 10F 950
CHAPTER 11 951
CHAPTER 12 954
CHAPTER 16 955
CHAPTER 18B 955
CHAPTER 19 956
Index 958