Diagnosis of Autism Spectrum Disorder by Developmental Behavioral Pediatricians in Academic Centers: A DBPNet Study
Hansen RL, Blum, NJ, Gahman A, Shults J for the DBPNet Steering Committee. Diagnosis of Autism Spectrum Disorders by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study. Pediatrics 2016:137(S2):s79-s89.
Developmental-Behavioral Pediatricians Complete Comprehensive Evaluations for ASD, but Vary in the Tests they Use: What can families expect when their child is referred to a developmental-behavioral pediatrician because of a concern about autism? This study asked 56 developmental-behavioral pediatricians at 12 academic medical centers across the United States to complete a survey right after a clinic visit in which they diagnosed a child with autism spectrum disorder (ASD). The survey included questions about the steps taken as part of the evaluation to make the diagnosis, other health care professionals involved in making the diagnosis, and tests used to understand the possible cause of the child’s autism.
Most developmental-behavioral pediatricians made the diagnosis of ASD after reviewing and discussing parent-completed questionnaires about child development and behavior, as well as completing developmental and ASD-specific testing with the child during one or more visits. Although there were differences across the sites in what testing was done and by whom, most of the time the testing was completed by the developmental-behavioral pediatrician. The majority of children given an ASD diagnosis were also given another co-occuring diagnosis, and almost a third were given two, such as speech/language disorders, intellectual disability, ADHD and sleep disorders. Most developmental-behavioral pediatricians recommended genetic testing to determine possible causes of ASD.
Future studies will try to identify which assessment practices are most efficient but accurate, so that we can decrease the wait time for diagnosis and treatment that many families face when their child is referred for an autism assessment.
Diagnosis of Attention-deficit/HyperactivityDisorder by Developmental Pediatricians inAcademic Centers: A DBPNet Study
Feldman HM, Blum NJ, Gahman A, Shults J on behalf of the DBPNet Steering Committee. Academic Pediatrics, 2015 – Volume 15 – p 282-288.
Developmental-Behavioral Pediatric Evaluations for ADHD include Developmental Testing and Multiple Informants: What can parents expect when their children’s primary care clinician refers a child to a developmental-behavioral pediatrician for assessment of Attention Deficit Hyperactivity Disorder (ADHD)? This study asked 52 developmental-behavioral pediatricians at 12 different academic medical centers what steps they take in making the diagnosis of ADHD. The respondents completed a survey form right after the diagnosis was made. In this way, the study learned what the doctors actually did in more than 200 cases rather than what they thought or remembered they did after time had passed.
We found many differences across the 12 sites. Sometimes the child was seen for one visit, sometimes for more than one visit. We also found several common approaches. The developmental-behavioral pediatricians almost always reviewed a parent-completed behavior rating scale or questionnaire about the child. They also very frequently reviewed a teacher-completed behavior rating scale or questionnaire about the child. They also reviewed or completed at least one developmental assessment of the child. This testing gives information about the child’s skills in addition to their behavior. In the vast majority of cases, they found that children had not only ADHD but at least one additional set of symptoms or one additional condition, such as learning difficulties or a sleep disorder. Even though the children in this study had ADHD, the doctors typically did not start the child on medication at the end of the diagnostic visits. Future studies will verify these findings using analyses of electronic medical records.
Research Training of Developmental-Behavioral Pediatrics Fellows: A Survey of Fellowship Directors by Developmental-Behavioral Pediatrics Research Network
Wiley, Susan MD*; Schonfeld, David J. MD†; Fredstrom, Bridget MA*; Huffman, Lynne MD†. Journal of Developmental & Behavioral Pediatrics: July/August 2013 – Volume 34 – Issue 6 – p 406–413
Objective: To describe research training in Developmental-Behavioral Pediatrics (DBP) Fellowship Programs.
Methods: Thirty-five US-accredited DBP fellowships were contacted through the Developmental-Behavioral Pediatrics Research Network to complete an online survey on scholarly work and research training.
Results: With an 83% response rate, responding programs represented 110 (87 filled) fellowship positions. External funding for fellowship positions was minimal (11 positions fully funded, 13 funded above 50% of cost). Structured research training included didactic lectures, web-based training, university courses, direct mentoring, journal clubs, and required reading. Of the 159 fellows described, spanning a 5-year training period, the majority chose projects relying on their own data collection (57%) rather than joining an existing research study and focused on clinical research (86%). Among 96 fellows with completed scholarly work, 29% were observational/epidemiological studies, 22% secondary analyses of large data sets, 16% community-based research, and 15% survey design. A limited number of fellows pursued basic science, meta-analysis/critical appraisal of the literature, or analysis of public policy. Barriers to successful fellow research are as follows: lack of time and money, challenges in balancing clinical demands and protected faculty research time, limited faculty research opportunities, time or expertise, and a lack of infrastructure for fellow research mentoring.
Conclusions: The scholarly work of fellows in DBP fellowship programs has primarily focused on clinical research using observational/epidemiological research and secondary analysis of large data set. Barriers largely in faculty time and expertise for research mentoring and inadequate funding in programs that have high clinical demands and little resources for research efforts were noted.
Blum, Nathan J. MD*; Feldman, Heidi M. MD, PhD†; Barbaresi, William J. MD‡; Schonfeld, David J. MD§; Hansen, Robin L. MD‖; Forrest, Christopher B. MD, PhD*
DBPNet Identifies Important Research Priorities for Developmental-Behavioral Pediatrics: We conducted a survey that included 27 developmental-behavioral pediatricians, 16 psychologists, and 12 parents to identify the most important research questions related to developmental and behavioral pediatrics. Initially each participant suggested up to 10 important research questions. The participants rated the importance of each question. There were 39 research questions rated as important by over half of the participants. Over half of these related to the effectiveness of medical, behavioral, or other types of interventions. Forty percent of the questions related to the etiology, diagnosis, or management of autism spectrum disorders. There were an additional 7 questions that more than 75% of the parents thought were important including question about how to best provide family support, facilitate effective transition to adulthood, detect pain in children with disabilities, and evaluate the effectiveness of speech therapy.
The Developmental-Behavioral Pediatrics Research Network: Another Step in the Development of the Field
Blum, Nathan J.; the DBPNet Steering Committee. Journal of Developmental & Behavioral Pediatrics. 33(1):78-83, January 2012.
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.