Rudolph's Pediatrics, 22nd Ed.

CHAPTER 79. Introduction to Developmental and Behavioral Pediatrics

Martin T. Stein

Developmental and behavioral pediatrics is the foundation that pediatric clinicians rely on in order to understand rapid changes in motor, social, and cognitive competencies and behaviors throughout childhood and adolescence. By applying knowledge about development and behavior at each stage of childhood and adolescence, pediatricians can separate healthy development and behavior variations from a clinical disorder. A critical component to achieving this clinical skill is a precise understanding of normal development and behavior at each developmental stage.

Recent discoveries in neuroscience provide clinically important insights into postnatal brain development in areas of neuroplasticity, synaptogenesis, and pruning (the retraction of synaptic connections with disuse). Confirmation that postnatal brain development is genetically controlled was not surprising. The discovery by neuroscientists that had the greatest effect on pediatric practice was the observations that postnatal brain architecture is also influenced by a child’s experiences. The environment does matter. Nurturing in early childhood is associated with healthy brain development; environmental deprivation restricts the ability of the brain to reach its genetic potential. The quality and sustainability of early relationships and a safe, stimulating environment support healthy brain maturation.

Psychosocial pediatrics was the precursor to the new specialty of developmental-behavioral pediatrics. The inclusion of a child’s psychological strengths and weaknesses in the context of a social environment can be found in the work of such pioneers of pediatrics as George Armstrong, Abraham Jacobi, and C. Aldrich Anderson. With conceptual and empirical contributions from neuroscience, psychology, sociology, and education, pediatricians now have the tools to apply evidence-based technologies in screening, evaluation, and treatment for many behavioral conditions and disorders associated with developmental delay.

Biopsychosocial pediatrics is the organizing force that facilitates a comprehensive clinical approach at each clinical encounter. It is a model for clinical practice that recognizes the shared influences of biology and environment in a social context. The goal of each clinical encounter is the inclusion of biological, social, and psychological data. Behavior and development in the biopsychosocial model are dependant on each other. The phenotype of many neurodevelopmental conditions is influenced by behavior, and behavioral conditions often have their origin in the development of the brain. Understanding a child’s developmental capacities and behavioral profile at each encounter is a guide to effective pediatric care.

This section reflects the integration of development and behavior. Fundamental principles of child development and behavior are followed by a description of contemporary knowledge of brain maturation. Behavioral conditions and developmental delays are framed in a spectrum from normal variations to clinical conditions. This important concept guides pediatric clinicians as they experience a wide variation of child and adolescent development and behavior in their daily practice. The section ends with a discussion of adaptations to illness and of resiliency, the ability to rebound from adversity.