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OBJECTIVE To understand developmental-behavioral pediatricians' (DBPs') use of clinic versus telephone encounters for preschool attention-deficit/hyperactivity disorder (ADHD) medication management. Understanding use of telephone encounters for pharmacologic management of ADHD in preschoolers may inform care for children with ADHD. METHODS DBP investigators within Developmental Behavioral Pediatrics Research Network abstracted data from medical records of 503 children aged younger than 72 months treated for ADHD with medication by a DBP clinician between January 1, 2013, and July 1, 2017, across 7 sites. We abstracted data about medication treatment episodes (defined as start and end/change of a specific type, dose, and frequency of ADHD medication) and encounter type (clinic vs telephone). We present descriptive statistics related to encounter types and χ2 analyses to compare frequencies across reasons for the end of treatment episode and across sites. RESULTS The study included 503 participants with a total of 1734 treatment episodes. The initial medication was started via a clinic encounter 85.9% of the time and via telephone encounters 14.1% of the time. When evaluating reasons for end of treatment episode, decreases in dose/frequency of medication were less common for clinic versus telephone encounters (27% vs 73%; p < 0.001) and adding an additional medication was more common at clinic versus telephone encounters (64% vs 36% p < 0.001). Sites varied significantly in frequency of telephone encounters, ranging from 16.9% to 68.9% (mean 45.7%). CONCLUSION Telephone encounters were used for pharmacologic management of ADHD in preschoolers to varying degrees across 7 DBP sites. These findings suggest that telephone management serves an important role in ADHD care.

Secondary analysis of existing large, national data sets is a powerful method to address many of the complex, key research questions in developmental behavioral pediatrics (DBP). Major advantages include decreasing the time needed to complete a study and reducing expenses associated with research by eliminating the need to collect primary data. It can also increase the generalizability of research and, with some data sets, provide national estimates that may form the basis for developing policy. However, few resources are available to direct researchers who seek to develop expertise in this area. This study aims to guide investigators with limited experience in this area who wish to improve their skills in performing secondary analysis of existing large data sets. This study provides direction on the steps to perform secondary analysis of existing data sets. It describes where and how data sets can be identified to answer questions of interest to DBP. Finally, it offers an overview of a number of data sets relevant to DBP.

OBJECTIVE To achieve consensus regarding important clinical, translational, and health services research questions for the field of developmental-behavioral pediatrics (DBP). METHODS Twenty-seven developmental-behavioral pediatricians, 16 psychologists, and 12 parents participated in a 3-round Delphi survey. Participation was 100% in Rounds I and III and 96% in Round II. In Round I, each participant suggested up to 10 research questions important for DBP in the next 5 years. In Round II, participants rated the importance of each unique question on a 9-point Likert scale. Questions were rated as consensus important questions if they had a median score of 7 and the 25th percentile was at least 6 or the coefficient of variation ≤30 (suggesting consensus). Questions were rated as potentially important if they had a median of 7, but a coefficient of variation >30 or if specific stakeholder group ratings suggested importance. After providing participants the Round II results, potentially important questions were rated a second time (Round III). RESULTS In Round I, 216 unique research questions were identified. In Round II, 29 of these questions met the criteria for a consensus important question and 60 questions were rated as potentially important. In Round III, 10 additional questions were rated as consensus important questions. Of the 39 consensus important questions, 20 were efficacy or comparative effectiveness studies and 40% related to autism spectrum disorders. CONCLUSIONS This Delphi process identified a set of high priority clinical, translational, and health services research topics for DBP that can guide research to advance the field and improve care and outcomes for children with DBP conditions.

This commentary recognizes the great accomplishment and future potential of research in developmental and behavioral pediatrics. It cautions against endorsing a longterm strategy of choosing relevant research topics based solely on today's population trends, as these are likely to change over time. The commentary supports DBPNet's own research emphases on autism and attention-deficit disorder based on their own interests and the specific goals supported by their funding mechanism.

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.

Objective The objective of this study was to offer a practical demonstration of the use of bootstrapping in structural equation modeling (SEM) with smaller samples by evaluating family dinnertime rituals at the intersection between the family social environment and pediatric type 1 diabetes mellitus management. Method Participants were 77 children and adolescents aged 6 to 18 years and their mothers from a larger study of child and parental challenges related to managing the treatment regimen and correlates of adherence. SEM was used to test a model of maternal reports of the family social environment as exogenous variables with mealtime rituals and child hemoglobin A1c levels as endogenous variables. The bootstrapping procedure and the Bollen-Stine bootstrapped χ test were then applied to test the stability and appropriateness of this model. Results Using SEM, the final model had robust goodness-of-fit indicators and revealed that the family social environment characteristics of control and cohesion were related to mealtime rituals, which was associated with hemoglobin A1c levels. The bootstrapping procedure indicated that the parameter estimates were very stable, thus lending greater credence to the model. The Bollen-Stine approach provided evidence that the entire hypothesized model was not significantly different from the model derived from bootstrapping. Conclusions This investigation offers a practical demonstration of the bootstrapping technique and the Bollen-Stine approach for testing models on smaller samples in SEM. These techniques may be used with relatively small samples, which are common in developmental/behavioral pediatrics and pediatric psychology research.

This study assessed the structure of pediatric resident developmental behavioral pediatrics (DBP) rotations in the context of the Accreditation Council for Graduate Medical Education duty hour mandates.: We distributed an online survey addressing rotation structure, call schedule, and impact of the duty hour policy to resident DBP rotation directors in 114 of 204 pediatric residency programs in the United States and Canada and received responses from 81 programs (71% response rate).Seventy-five percent of respondents reported an average of 16% reduction in their DBP rotation after implementation of the Duty Hours rule in 2003. More programs having overnight calls during the rotation reported decreases versus those without overnight calls (91% vs 52%, p.001).Decreases in exposure to DBP, a result of duty hour mandates, may be negatively impacting benefits of mandatory DBP rotations. Attention may need to be given to the consequences for resident education in DBP.

This article discusses single-case experimental designs (SCEDs) and their relevance to developmental-behavioral pediatrics. Information concerning SCEDs have not been described in the Journal of Developmental and Behavioral Pediatrics, despite its relevance to the field. General issues related to the underlying logic and applications of SCEDs are reviewed with examples selected from the literature to illustrate the strengths and weaknesses of different design strategies. It is suggested that SCEDs can be a useful alternative to traditional between-group designs for clinical and evaluation research because the unit of the analysis is the individual; therefore the feedback to clinicians and families is direct about the effectiveness of a behavioral intervention or medication for that individual. In the field of developmental-behavioral pediatrics, SCEDs can be especially useful in the management of vague symptoms or poorly defined diseases to improve the confidence in a treatment decision for an individual patient. This report is intended to facilitate the understanding and use of single-case methodology so that clinicians are aware that flexible, true experiential designs exist to fill the gap in knowledge and also "do the best for my patient."

This article is the first to evaluate pediatricians’ (1) current practices regarding recommendations for toilet training typically developing first-time learners and (2) opinions on an intensive procedure for rapid toilet training. Results of surveys obtained from 103 pediatricians indicate that physicians’ recommendations lean toward a gradual, passive approach to toilet training with 72% endorsing “child interest” in the toilet as one of the top criteria children must exhibit before beginning training. Respondents had a somewhat unfavorable view of intensive toilet training for first-time learners with 29% endorsing the use of such a procedure, although in most cases without all of the components. It is recommended that some components of the intensive procedure could easily “fit” with physicians’ current practices to increase toilet-training effectiveness within a shorter training interval. These recommendations, including compliance training as a part of teaching, increased fluid intake to promote toileting trials, and multiple training sits, are described.

The objective of this study was to compare the behavior of healthy young children around feeding and mealtimes to the behavior of two clinical groups, children referred for feeding problems without related medical issues and those with medical issues associated with the feeding problems. Using the Behavioral Pediatrics Feeding Assessment Scale, data were obtained for 96 healthy children between the ages of 9 months and 7 years, and descriptive information is presented in the paper on these normal mealtime behaviors. In comparing this normative data to similar data obtained from the clinical groups, our primary purpose was to investigate whether children with feeding problems engage in fundamentally different behaviors (maladaptive) or similar behaviors, but at an increased frequency to normal children. Factor analysis identified five common patterns of behavior across the three groups. The difference in parental report of feeding difficulties between healthy and clinical groups appears to reflect the frequency in which the child with feeding difficulties engages in the problematic behavior, rather than fundamental differences in behaviors exhibited during mealtimes.

The discovery and characterization of thousands of genes involved in human disorders has the potential for great benefit in patient diagnosis and treatment. A combined approach using molecular genetic testing for some disorders as an adjunct to the clinical evaluation of children with developmental or behavioral features is rapidly occupying a more prominent role in the diagnostic evaluation. In some instances, molecular testing might confirm a genetic etiology in a child initially referred with a DSM-IV diagnosis, but molecular testing might be of limited use in other instances. This review presents advances in the diagnosis of inherited disorders affecting the pediatric population, with an emphasis on those with a developmental/behavioral component. We examine several relatively common disorders in detail (and less common disorders in a more cursory fashion) to elucidate the strengths and weaknesses of molecular diagnosis in clinical practice.