Critical Issues in Developmental and Behavioral Pediatrics

I. Introduction: General Issues in Developmental Disorders.- 1 State of the World's Children: Developmental-Behavioral Disorders in a Global Context.- 1. Introduction.- 2. Children in History.- 3. Children Today.- 4. Recent Nutrition Data.- 5. Children Tomorrow.- 6. Conclusions.- References.- 2 PL 99-457: A New Challenge and Responsibility for Physicians.- 1. Introduction.- 2. Physician Involvement.- 2.1. Identification.- 2.2. Medical Evaluation.- 2.3. Communication with the IFSP Team.- 2.4. Family Support.- 2.5. Participation in the IFSP Process.- 2.6. Advocacy.- 3. Barriers to Physician Involvement.- 4. Overcoming Barriers.- Selected Readings.- 3 An Ethical Issue in Developmental Pediatrics: Analysis and Discussion of a Case History.- Case History-S. L., a Newborn with Partial Trisomy-13.- Reference.- Selected Readings: Ethical-Legal Issues.- 4 A Physician's Primer of Developmental and Psychologic Test Instruments.- 1. Introduction.- 2. Possible Developmental Delay.- 2.1. Developmental (Cognitive/Motor) Delay.- 2.2. Language Delay.- 2.3. Behavioral/Adaptive Delays.- 3. Cases Involving Suspected Developmental Delay.- 4. Difficulties in School Performance.- 4.1. Intelligence.- 4.2. Academic Achievement.- 4.3. Perceptual/Visual Motor.- 4.4. Attention/Concentration.- 4.5. Behavioral.- 5. Cases Involving Suspected School Problems.- 6. Conclusions.- References.- II. Developmental Disorders.- 5 Neonatal Brain Care: Does Early Developmental Intervention Work?.- 1. Introduction.- 2. Supplemental Stimulation.- 3. Protection at All Costs.- 4. Contingency-Based and Developmentally-Based Interventions.- 5. Summary.- References.- 6 Early Identification of Cerebral Palsy.- 1. Introduction.- 2. Types of Cerebral Palsy.- 3. Early Clinical Signs of Cerebral Palsy.- 3.1. Amiel-Tison et al. (1977).- 3.2. Ellenberg and Nelson (1981).- 3.3. Harris (1987).- 3.4. Research Conclusions.- 4. Summary.- References.- 7 Movement Disorders and Paroxysmal Behaviors in Children and Adolescents.- 1. Introduction.- 2. Disorders Characterized by Alteration in the State of Consciousness and Abnormal Movements.- 2.1. Seizure Disorders.- 2.2. Pseudoseizures.- 3. Disorders Characterized Primarily by an Alteration in Consciousness.- 3.1. Syncope Due to Inadequate Cerebral.- 3.2. Postural Hypotension.- 3.3. Steal Syndromes.- 3.4. Cardiac Arrhythmias.- 3.5. Breath Holding Spells.- 3.6. Syncope Due to Hypoxia or Hypoglycemia.- 4. Disorders Characterized Primarily by Abnormal Movements.- 4.1. Disorders Characterized by Hyperkinesia.- 4.2. Disorders Characterized Primarily by Abnormalities of Posture and Tone.- 4.3. Disorders Characterized Primarily by Akinesia.- 5. Other Paroxysmal Disorders.- 5.1. Rett Syndrome.- 5.2. Mannerisms.- References.- 8 Epilepsy: Implications for Intelligence, Learning, and Behavior.- 1. Introduction.- 2. Epilepsy and Intelligence.- 3. Epilepsy and Learning Difficulties.- 4. Epilepsy and Childhood Emotional and Behavioral Disorders.- 4.1. Anticonvulsants and Behavior Disorders.- 4.2. Temporal Lobe Epilepsy and Psychiatric Disorders.- 5. Summary.- References.- 9 Learning Disabilities: "The Good News/The Bad News".- 1. Introduction.- 2. Toward a Definition.- 3. Significant Discrepancy.- 4. Research.- 5. The Future.- References.- 10 Lessons I've Learned from Learning Disabilities.- 1. Introduction.- 2. Overlooked Learning Disability.- 2.1. Emotional Disturbance and Underachievement.- 2.2. Headaches and Fatigue.- 3. Miscellaneous Lessons I Have Learned.- 3.1. "Abnormal Depth Perception" in a Clumsy Child.- 3.2. Involuntary Movements with Accompanying Behavioral Upset.- 3.3. Refusal to Speak in an Anxious Child.- 3.4. Cerebral Palsy with Accompanying Depression.- 3.5. Newly Acquired Perceptual Disorder in an Intelligent Child.- 3.6. Situational Depression with a Well-Controlled Seizure Disorder.- 3.7. Acute Psychosis with Temporal Lobe Epilepsy.- 3.8. Declining School Performance and the Misdiagnosis of Seizures.- 3.9. Adolescent Stroke with Complicating Emotional Handicap.- 3.10. Seizures Misdiagnosed as Tics.- 3.11. Unappreciated Visual Difficulties Simulating Visuo-Perceptual Handicap.- 3.12. Clumsiness and Overactivity with a Posterior Fossa Brain Tumor.- 4. Summary.- Reference.- 11 Head Injury: After Acute Care, Then What?.- 1. Introduction.- 1.1. General Considerations.- 1.2. Fantasy and Reality.- 2. Definitions/Incidence.- 3. Phases of Recovery, Acute Stages.- 3.1. General Considerations.- 3.2. Physical Recovery.- 3.3. Agitated Behavior.- 4. Phases of Recovery, Potential Chronic Handicaps.- 4.1. General Considerations.- 4.2. Attention and Memory Deficits.- 4.3. Intellectual Impairment.- 4.4. Communication Disorders.- 4.5. Learning Disabilities.- 4.6. Problems in Vocational Performance.- 4.7. Social Adjustment Difficulties.- 4.8. Poor Self-Image.- 5. Rehabilitation Strategies.- 5.1. General Considerations.- 5.2. Cognitive Remediation.- 5.3. Educational/Vocational Rehabilitation.- 5.4. Psychotherapy/Psychopharmacology.- 6. Prognosis.- 6.1. The Patient.- 6.2. The Family.- 7. Summary/Personal Perspectives.- References.- 12 Clefting Syndromes: A Review.- 1. Introduction.- 2. Embryological Considerations.- 3. Incidence and Epidemiology.- 4. Genetic Considerations.- 4.1. Threshold Traits.- 4.2. Etiologic Distinction.- 5. Syndromic versus Nonsyndromic Clefts.- 6. Summary.- References.- 13 Fragile X Syndrome.- 1. Introduction/Incidence.- 2. Genetic Background.- 3. Physical Characteristics.- 4. Behavioral Manifestations.- 5. Mental Retardation.- 6. Cognitive Profile.- 7. Neurological Problems.- 8. Neuroendocrine Disorders.- 9. Nonpenetrant Males.- 10. Females and Fragile X Syndrome.- 11. Recent Genetic Findings/Genetic Counseling.- 12. Theraphy.- 13. Summary.- References.- 14 Down's Syndrome.- 1. Introduction/Incidence/Etiology.- 2. Characteristics.- 2.1. Cardiac Problems.- 2.2. Gastrointestinal Problems.- 2.3. Ophthalmological Disorders.- 2.4. Disorders of the Ears, Nose, and Throat.- 2.5. Orthopedic Disorders.- 2.6. Endocrine Disorder.- 2.7. Neurological Problems.- 2.8. Leukemia.- 2.9. Dental Problems.- 3. Summary.- References.- 15 Controversial Therapies in Developmental Disabilities.- 1. Introduction.- 2. Additive-Free Diet.- 2.1. The Feingold Hypothesis.- 2.2. Experimental Studies.- 2.3. Potential Adverse Effects.- 3. Orthomolecular Vitamin Therapy.- 3.1. Development of the Hypothesis.- 3.2. Experimental Studies.- 3.3. Potential Adverse Effects.- 4. Orthomolecular Mineral Therapy.- 4.1. Origin of the Theory and Hair Analysis.- 4.2. Experimental Studies.- 4.3. Potential Adverse Effects.- 5. Behavioral Responses to Carbohydrates.- 5.1. The Carbohydrate Hypothesis.- 5.2. Experimental Studies.- 5.3. Potential Adverse Effects.- 6. Summary.- References.- III. Neurobehavioral and Emotional Disorders.- 16 Neuropharmacological Therapies: Potential Neurodevelopmental and Behavioral Complications.- 1. Introduction.- 2. Theophylline.- 3. Stimulant Medication and Tics.- 4. Anticonvulsant Drugs.- 5. Summary.- References.- 17 Attention Deficit Disorder: All You Wanted to Know but Were Afraid to Ask.- 1. Introduction.- 2. Diagnostic Evaluation.- 2.1. History-Taking.- 2.2. General Medical Examination.- 2.3. Neurological Examination.- 2.4. Laboratory Testing.- 3. Therapy.- 3.1. Nonstandard Therapy.- 3.2. Stimulant Medication.- 3.3. Nonstimulant Medication.- 4. Prognosis.- References.- 18 Anticipatory Guidance: New Responsibilities for Pediatricians.- 1. Introduction.- 2. Health Education.- 3. Well-Child Care.- 3.1. Group Well-Child Care.- 3.2. Parenting Classes.- 4. Injury Control.- 4.1. Legislation.- 4.2. Behavioral Approaches.- 5. Medical Compliance.- 5.1. Physician Factors.- 5.2. Patient Factors.- 5.3. Parent Factors.- 5.4. Regimen Factors.- 5.5. Disease Factors.- 5.6. Assessment of Noncompliance.- 6. Conclusion.- References.- 19 When Baby Just Won't Sleep.- 1. Trained Night Feeders.- 1.1. Etiology.- 1.2. Management.- 1.3. Ineffective Interventions.- 2. Trained Night Criers.- 2.1. Etiology.- 2.2. Evaluation.- 2.3. Management.- 2.4. Ineffective Interventions.- 3. Fearful Night Criers.- 3.1. Etiology.- 3.2. Management.- 4. When Sleep Problems Lead to Child Abuse.- 5. Co-Sleeping: Helpful or Harmful?.- 5.1. What Studies Show.- 5.2. Advantages and Disadvantages.- 5.3. Goals.- 5.4. Changing the Habit.- 6. Appendix: Night Awakening in Older Infants.- 6.1. Definitions.- 6.2. Trained Night Feeders.- 6.3. Trained Night Criers.- 6.4. Fearful Night Criers.- 6.5. Steps to Take for All Types of Sleep Problems.- References.- 20 Toilet Training Refusal: Avoid the Battle and Win the War.- 1. When Does Training Usually Occur?.- 2. Organic Etiologies.- 3. The Classic Pattern: A Power Struggle.- 4. Myths about Etiology.- 5. Evaluating the Problem.- 6. A Plan for Treating Classic Resistance.- 7. What the Doctor Can Do to Help.- 8. When a Child Needs Extra Help.- 9. Heading Off Problems before They Start.- 10. Summary.- 11. Appendix: Toilet Training Resistance.- 11.1. Definition.- 11.2. Home Care for Toilet Training Resistance.- References.- 21 Interview and Intervention Strategies for Adolescents.- 1. Introduction.- 2. General Principles for Interviewing Adolescents.- 2.1. Interview the Parents and Adolescent Separately.- 2.2. Establish Rapport and Set Tone of Interview.- 2.3. Maintain Confidentiality.- 2.4. Obtain Complete Information.- 2.5. Allow Sufficient Time for the Interview.- 2.6. Summarize Sessions.- 3. Suggestions to Improve the Communication Process.- 3.1. Express Empathy.- 3.2. Ask Open-Ended Questions.- 3.3. Actively Listen.- 3.4. Observe Nonverbal Cues.- 3.5. Reflect and Repeat.- 4. Difficult Interviewing Situations.- 4.1. The Angry Patient.- 4.2. The Crying Patient.- 4.3. The Silent Patient.- 5. Components of the Psychosocial Evaluation.- 5.1. Basic Components.- 5.2. Recognition of the Teen in Trouble.- 5.3. When to Refer.- 6. Common Blunders.- 6.1. Identifying with the Adolescent.- 6.2. Identifying with the Parent.- 6.3. Moralizing.- 6.4. Giving Advice.- 6.5. Ignoring Parents.- 7. Summary.- References.- 22 The Sexually Active Adolescent.- 1. Introduction.- 2. Extent of Sexual Activity among Teens.- 2.1. Comparison Data: 1950s to 1970s.- 2.2. Contributing Factors.- 3. Attitudes toward Sex.- 4. Homosexuality.- 5. The Sexual History.- 6. Common Problems Concerning Sexuality.- 6.1. Fears and Fantasies.- 6.2. Sex for Nonsexual Reasons.- 6.3. Sexual Dysfunction.- 7. Approach to the Sexually Active Adolescent t1322].- References.- 23 Divorce: Stopping the Mayhem.- 1. Introduction.- 2. Conflict.- 3. Modeling.- 4. Spying.- 5. Social Life Privacy.- 6. Visitation.- 7. Money Issues.- 8. Professional Options.- 8.1. Primary Care Counseling.- 8.2. Mediation.- 8.3. Divorce Workshops.- 8.4. Divorce Attorneys.- 9. Contested Custody Cases.- 10. Concluding Remarks.- References.- Suggested Readings.- IV. General Issues.- 24 The Parent-Physician Relationship: An Essay on Bonding.- 1. Introduction.- 2. The Bond for the Patient.- 3. Bonding Effects on the Physician.- 4. Personal Reflections.- References.- 25 Family and Career: Some Personal Reflections.- 1. Introduction.- 2. A Datum.- 3. The Househusband.- 4. Findings.- 5. Reentry.- 6. Conclusion.- References.