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.