Developmental pediatrician Ruth E.K. Stein believes that child development and behavior (DB) form the foundation of pediatrics. She wonders whether or not modern, general pediatricians are “on the right track” and adequately consider DB when it comes to clinical care, teaching, and research activities. Writing in this month’s issue of Pediatrics, Dr. Stein doesn’t think so:
The epidemiologic facts speak for themselves: the percentage of children with DB issues has doubled; autism diagnoses and early identification of DB issues have increased; ∼20% have chronic health conditions; ∼20% of children have mental health (MH) diagnoses, which are now the most costly chronic conditions of children. All 5 of the top conditions causing disability in 2008–2009 are in our domain, ahead even of asthma. A survey by the American Academy of Pediatrics reveals that 41% of parents of school-aged children had concerns about learning difficulties and 36% about depression and anxiety; 11.5% of children were diagnosed with a learning disability; 8.8% with attention-deficit/hyperactivity disorder; 6.3% with behavior problems. It isn’t just the small proportion of children with severe disorders who need our attention! Most parents are concerned at some point about some aspect of their children’s behavior and development.
Parents don’t want their children to “stand out” among their peers, unless, of course, they are head-and-shoulders above the rest academically, on the field of play, or onstage. Children with developmental and intellectual disabilities (including autism, ADHD, and learning disabilities), those with behaviors that draw attention to themselves, and those children with special health care needs (CSHCN) are the obvious ones who stand out in a society that seems to treasure “sameness.” Children, ‘tweens, and teens with mental health disorders, which occur at higher frequencies in the groups just mentioned, may take a while to garner enough attention in order for us to take note and demand evaluations and treatments. By then, they may be considered “outsiders” by their peers. Then there are those children who, by simply being “different,” (by race, or religion, or sexual orientation/gender identity), really freak people out; anyone who attempts to celebrate these differences in public exposes themselves to ridicule and bullying, as unjust as that is.
No one is perfect — we’ve all got something going on. Dr. Smith proposes five steps pediatricians can take in order to allow a better understanding of our developmental differences and behavioral idiosyncrasies. One hopes that would help all of us to become more tolerant and willing to respect those in need. We need more of that.