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Frequently Asked Questions . . .
Developmental/Behavioral Pediatrics
What is a developmental disorder?
Developmental disorders are those problems that result from impairment in typical biological, psychological, or social processes. These impairments can have their onset before birth, during the labor and delivery process, or after birth. Developmental problems can be due to a single reason, multiple reasons, or no discoverable reason. Similar behaviors can be due to difference causes. The multifaceted role of the developmental/behavioral pediatrician is to determine whether there are treatable causes of a developmental disorder and to recommend a plan of action to improve developmental outcome.
What kinds of problems does a developmental/behavioral pediatrician diagnose?
We focus on the differential diagnosis of various developmental conditions that result in delayed milestones, inability to communicate effectively, poor attention focusing, hyperactivity, impulsivity, learning problems, poor or atypical social interactions, disruptive behavior problems, sleep disturbance, sensory processing problems, coordination problems, mood or anxiety problems, or other symptoms that adversely affect a child’s development.
What happens during a developmental medical evaluation?
Our main goal is to help parents (or guardians) understand how to help their children reach their best potential. We do that in several ways.
For an initial assessment we perform a comprehensive developmental medical evaluation. This means interviewing parents/guardians, and doing an examination that consists of observations, interactions, physical and neurological clinical exams, and review of records.
We will want to review all the previous evaluations the child has had. If the child has been in therapy, we would also want information from the people who have worked with the child. We will also want to review any previous medical testing the child has had.
Will the evaluation include any kind of testing?
Depending on the kind of testing the child has had, we may or may not need to do more or different kinds of testing as part of our evaluation. As developmental/behavioral pediatricians we often work with other disciplines in a team structure. The other team members may include any or all of the following: a clinical social worker; a nurse practitioner; a speech/language pathologist; a psychological examiner; a clinical psychologist.
Testing options include developmental or behavioral rating forms, speech/language testing, psychoeducational testing, or assessments for comorbid or confounding mental health conditions. Hearing or vision tests may be recommended, if indicated. Blood or urine testing for metabolic or genetic conditions may be recommended if indicated. Likewise, brain or skeletal imaging studies may be recommended if indicated.
Will a diagnosis be given as part of the evaluation?
After we have enough information to form diagnostic impressions, we share that information with parents/guardians, usually on the day of the visit. We may be able to give a definitive diagnosis. If we cannot, we will explain why, and tell what needs to happen next to try to find that answer. Sometimes, we realize there may never be a definitive diagnosis. If that is the case, we will tell why, and what should be done next.
Will a report be available with the results of the evaluation?
We follow up with a written report of our evaluation that can be shared with whoever the parents/guardians choose.
Will follow-up visits be necessary?
Many times a diagnostic consultation requires only one visit to satisfactorily answer the referral questions. Sometimes it will be preferable to see the child periodically over months or years to measure developmental progress. Sometimes it is necessary to use psychotropic medication to target specific developmental impairments. Many primary care providers agree to monitor children who need such medications if the developmental specialist can periodically consult with the family about the medication. We are available to provide this service to our families and referring physicians.
Physical Medicine and Rehabilitation
What is Cerebral Palsy?
Cerebral palsy simply refers to a condition of motor disability (problems with movement, tone, and posture) due to a problem with the brain that is static (won't get worse over time) and occurs early in development. Severity and body parts affected vary tremendously. Sometimes orthopedic complications develop as a child grows, but the brain lesion does not get worse or deteriorate.
Is all Cerebral Palsy due to lack of oxygen at birth?
No! The most common cause is intraventricular hemorrhage (bleeding in the brain) related to prematurity, and children typically have more stiffness in the legs than the arms as a result; the pattern is called spastic diplegia. The term periventricular leukomalacia may also be used in association with this type of cerebral palsy and refers to how the white matter close to the ventricles of the brain is injured and appears on CT or MRI scans. There are many other causes, and only about 10% of cases are related to lack of oxygen.
I thought Botox was for wrinkles, but my child's therapist is suggesting we try it for her stiff muscles. Can you explain?
Botox is actually botulism toxin, the same thing that makes people very ill if they get it in their food. But purified and injected into a muscle, it relaxes or weakness that specific muscle with relatively few if any side effects. It can be very helpful to allow children affected by spasticity or dystonia to move more easily. You can learn more about it and whether it could help you or your child at a Habilitation clinic visit. (Sorry, we don't do wrinkles here!) Other treatments such as medications and intrathecal baclofen pump can also be considered.
My child has an appointment in the Muscular Dystrophy Clinic; does this mean he or she has Muscular Dystrophy?
No, the MDA supports our clinic, but it covers a wide variety of conditions including not just the dystrophies (there are many kinds, varying in severity) but also myopathies (usually milder, less severe or non-progressive muscle diseases), neuropathies such as Charcot-Marie-Tooth disease, and anterior horn cell and multisystem diseases.
The Progressive Rehabilitation Unit sounds like a wonderful service, but I would rather my child never needed it. What can I do?
Not all injuries or conditions requiring inpatient rehabilitation are preventable, but you can reduce your risks substantially by buckling up every ride, using car seats and booster seat according to best practices, (see http://www.archildrens.org/community_outreach/safety_tips/child_passenger.asp ) wearing helmets when "on wheels" (bicycles, moped, scooter, skates, skateboards, ATVs) and not riding as a passenger on an ATV, not driving one at all before age 16, and NEVER riding or allowing a child to ride in any vehicle driven by an intoxicated person. Don't dive into shallow water; "feet first, first time!" Always designate one adult to be the supervisor for any small child or non-swimmer around a pool or other body of water. Near-drownings commonly happen when more than one adult is involved, and each adult thinks the others are watching. Another excellent ACH resource on this topic with additional ways to reduce injury risks for children is http://www.archildrens.org/community_outreach/injury_free_coalition.asp.
My child had a head injury, was sent home from the hospital, and can walk and talk without difficulty, but suddenly can't function in school and has behavioral and emotional problems. Is this just stress due to the accident, and will it go away?
Please contact us for help. Often there are "post-concussive" symptoms and sometimes persistent problems that can be limited in their effect by better understanding and modifications to the classroom and environment. When unrecognized and mislabeled as emotional or willful behavior, these problems can have a long lasting adverse impact on a child's educational and family experience.
What kind of follow-up is needed for these conditions?
The follow-up needed for each child is individualized and may be only one or two visits or may be lifelong, particularly in the case of spinal cord injuries. We see continue to see some children long term even into adulthood, and others are helped to transition to adult providers.
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