By Tom Scott, MD, FAAP, Interim Director, Developmental-Behavioral Pediatrics Residency Program, University of Minnesota
The care of all infants, children and adolescents involves Developmental-Behavioral Pediatrics (DBP), whether by primary pediatricians or DBP specialists. Composing a relatively new sub-specialty, DB pediatricians provide care for a range of patients with developmental, learning, emotional, and behavioral disorders. Similar to primary care pediatricians, DB pediatricians also focus on healthy child and adolescent development, identifying strengths, promoting resilience, and reducing risk.
DB pediatricians work as individual consultants or in teams. Team members from other disciplines may be on site or in the community and include speech and language pathologists, audiologists, psychologists, nurses, education specialists, occupational therapists, physical therapists, nutritionists, neurologists, geneticists, and child psychiatrists. Sometimes primary care pediatricians consult directly with these other team members.
Whether a patient should be referred to a DB pediatrician, a child psychologist, or child psychiatrist and whether to an individual consultant or to a team depends on the nature and complexity of the problem and availability of specialty resources. Sometimes a referral to a person on the team will result in a recommendation for additional assessment by other team members. There may be overlap in the clinical expertise of specialists on the team, and in complex cases, additional perspectives may be particularly helpful diagnostically. DB pediatricians in Minnesota have varying areas of specialization, including autism, early childhood issues, ADHD, learning disorders, Down’s syndrome, sleep, self-regulation, and hypnosis. Also, some general pediatricians have special interests in DBP and serve as resources for other clinicians.
The following are general guidelines in making referral and consultation requests to DB pediatricians, child psychologists, and child psychiatrists:
Referral/consult request to Developmental-Behavioral pediatrician:
– Complicated school learning,attention, and behavior problems
– Questions of autism spectrum diagnosis and management
– Anxiety and depression
– Persistent somatic symptoms
– Persistent elimination and soiling problems
– Sleep issues
Referral/consult request to child psychologist:
– Questions of co-morbidity with learning and attention problems
– Questions of cognitive status
– Differential diagnosis of anxiety, depression, behavioral issues
– Questions of autism spectrum diagnosis and management
– Individual or family therapy
– Cognitive behavioral therapy
Referral/consult request to child psychiatrist:
– Out of control behavior
– Suicidal issues
– Questions of bi-polar disorder
– Questions of psychosis
Pediatricians in Minnesota, like those throughout the country, have concerns about the availability of DB pediatricians and long waiting lists. At present, almost all DB pediatricians in Minnesota are located in the metro area. A recent study found 86 percent of primary care pediatricians in the United States reporting too few DB pediatricians and 95 percent reporting too few child/adolescent psychiatrists to meet the needs of patients in their practices. In 2011 only 35 first-year DBP fellows were in training in the United States.
In order to address the shortage of DB pediatricians, advocacy at a federal, state and local level is essential.
References:
The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, Third Edition, Marilyn Augustyn, Barry Zuckerman, Elizabeth B. Caronna, editors, 2011.
Encounters with Children, Pediatric Behavior and Development, Fourth Edition, Suzanne D. Dixon and Martin T. Stein, 2006
Primary Care Pediatricians’ Satisfaction with Subspecialty Care, Perceived Supply, and Barriers to Care, Journal of Pediatrics, 2011, Vol. 156, No. 6,1011-1015
