Subspecialty certification in developmental-behavioral pediatrics: past and present challenges

Defining Developmental-Behavioral Pediatrics

There is an insufficient number of specialty developmental-behavioral pediatrics (DBP) physicians, despite nearly 25% of children and adolescents having a developmental, learning, behavioral, or emotional problem. In the nearly 20 years since becoming a board-certified subspecialty, the definition of DBP clinical practice remains somewhat unclear. This lack of clarity likely contributes to recruitment challenges and workforce issues, and limited visibility of DBP among parents, other professionals, payors, and administrators. Defining DBP is therefore an important step in the survival and growth of the field. In this paper, we describe the methodology used to develop this definition along with the origins of DBP, the persistent challenges to defining its scope, what training in DBP involves, and what distinguishes DBP from other overlapping fields of medicine. We propose the following definition of DBP: developmental-behavioral pediatrics (DBP) is a board-certified, medical subspecialty that cares for children with complex and severe DBP problems by recognizing the multifaceted influences on the development and behavior of children and addressing them through systems-based practice and a neurodevelopmental, strength-based approach that optimizes functioning. Developmental behavioral pediatricians care for children from birth through young adulthood along a continuum including those suspected of, at risk for, or known to have developmental and behavioral disorders.

The Developmental-Behavioral Pediatrics Research Network: another step in the development of the field

Developmental-behavioral pediatrics was formally recognized as a subspecialty of pediatrics in 1999 with one of the goals being to promote research in the field. However, research has generally been a small component of most developmental-behavioral pediatricians' activities. In an effort to expand research in the field, the Developmental-Behavioral Pediatrics Research Network (DBPNet) was funded through a cooperative agreement with the Health Resources and Services Administration, Maternal Child Health Bureau. This funding supports the development of an infrastructure to support multisite research that aims to optimize the health and functional status of children with developmental and behavioral concerns and disorders. This article describes the need for a developmental-behavioral pediatrics research network, the development of the infrastructure for DBPNet, and the mechanisms for investigators to collaborate with the Network.

The pediatric subspecialty workforce: public policy and forces for change

Policy has not adequately addressed the unique circumstances of pediatric subspecialties, many of which are facing workforce shortages. Pediatric subspecialties, which we define to include all medical and surgical subspecialties, are discrete disciplines that differ significantly from each other and from adult medicine subspecialties. Concerns about a current shortage of pediatric subspecialists overall are driven by indicators ranging from recruitment difficulties to long wait times for appointments. The future supply of pediatric subspecialists and patient access to pediatric subspecialty care will be affected by a number of key factors or forces for change. We discuss 5 of these factors: changing physician and patient demographics; debt load and lifestyle considerations; competition among providers of subspecialty care; equitable reimbursement for subspecialty services; and policy to regulate physician supply. We also identify issues and strategies that medical and specialty societies, pediatric subspecialists, researchers, child advocates, policy makers, and others should consider in the development of subspecialty-specific workforce-policy agendas.

Pediatricians' training and identification and management of psychosocial problems

This study evaluated the association of pediatrician training on the identification and management of current and ongoing emotional or behavioral problems among children ages 4-8 years in 19 practices in south-central Connecticut. Pediatricians with advanced training in psychosocial issues were more likely to identify children's psychosocial problems and use multiple management strategies compared with pediatricians with no specialized training. Although pediatricians with moderate training in psychosocial issues were more likely to identify psychosocial problems compared with pediatricians with no training, there was no relationship between moderate training and management of psychosocial problems. These results suggest that identification and management of young children's psychosocial problems demands advanced training and support the American Academy of Pediatrics' call for more extensive training.