Nearly 20% of children in the United States have developmental disabilities such as Autism Spectrum Disorder (ASD), ADHD, learning disabilities, and speech disorders. These disorders are usually diagnosed in childhood and receive specific lengthy treatments based on severity.
The prevalence of these disorders, including autism, is rising. The Centers for Disease Control and Prevention recently announced that her one child in her 36, a record high, has the condition. Because early intervention can alter a child’s prognosis, general pediatricians play a critical role in identifying early signs of these conditions and making referrals based on developmental screening and monitoring.
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When a general pediatrician suspects a diagnosis of autism or ASD, the family can be referred to a developmental and behavioral pediatrician such as ours for a more specialized or intensive evaluation and ongoing care. But our field is in trouble, and if it doesn’t survive, pediatricians in general can’t afford to do everything they’ve been doing, plus more comprehensive training, to develop developmentally. The condition needs to be managed. I fear that the changes affecting our field will prevent many children from receiving the most thorough care Developmental and Behavioral Pediatrics can provide.
Board-certified developmental and behavioral pediatricians are now responsible for teaching pediatric residents about child development and developmental disorders. Studies estimate that 1 in 4 of her family members have concerns about a child’s development, so training provided by experienced and knowledgeable clinicians is important. However, the U.S. College of Graduate Medical Education, the governing body that sets these requirements, wants to repeal this requirement and instead leave that training to lay pediatricians. and delayed or inadequate treatment.
As part of this training, we spend 1-2 months with these residents to help them understand both a disorder such as autism and how to recognize its early signs. We educate them about evidence-based treatment recommendations, including those we use regularly. We don’t have enough time to share everything we know, but developmental and behavioral pediatricians believe that pediatricians in general should be aware of these childhood disorders and have more confidence in their assessment. It helps to introduce
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We are not asking a pediatrician in general to tell us how to treat childhood cancer, seizures, or diabetes, but this is what colleges are suggesting when it comes to developmental disorders.
I understand why colleges want to do this. We are too few in number, and allowing a lay pediatrician to teach residents will bring flexibility to a program that cannot be hired from an already scarce pool of developmental and behavioral pediatricians. But this proposal leads to bigger problems within pediatrics. Most subspecialists make less money than general pediatricians.To make an accurate diagnosis takes time and collaboration with other disciplines such as psychology, speech pathology, occupational therapy, and educators. This means fewer patients, and we cannot always charge for this time. Additionally, developmental and behavioral pediatricians do not have the reimbursement rates of surgical specialists or pediatricians who see more patients. This means that few pediatricians choose our path because their salaries are insufficient to pay off six-figure medical school loans or they are not exposed to them. The ACGME proposal will not remedy these problems and will almost certainly contribute to the deficit of developmental and behavioral pediatricians.
Our expertise has grown with the success of vaccines and antibiotics. The focus of pediatrics has shifted from protecting children’s lives from fighting infectious diseases to optimizing lives by monitoring child development and managing mental and behavioral health problems. New subspecialties outside of general pediatrics and child psychiatry were needed to better manage these issues. This is with expertise in advocacy, expected and unexpected developmental pathways, learning, and emotional health.
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What ACGME is proposing is that families of neurodiverse children will have fewer resources for comprehensive diagnosis and ongoing care than they currently have. This proposal would affect the education system and other service organizations for individuals with developmental delays and disabilities, as children and families may not be able to access special services without an appropriate and accurate diagnosis. give.
Additionally, pediatricians in general have a lot of work to do. They manage a child’s mental health crisis, a respiratory “triple infection,” and unnoticed parenting during her COVID-19 pandemic. With the pandemic and behavioral health crisis, a pediatrician has learned to manage mental health issues without enough community her therapists and specialized training in more complex medication administration. I am forced. They can’t do it all at once, and the added work of diagnosing and treating developmental delays and disorders inevitably leads to moral distress and ultimately burnout.
Other options are also available. First, technology will enable education and clinical instruction throughout the pediatric residency system. ECHO Autism is a virtual mentoring and education option that democratizes knowledge and gives clinicians access to specialized care in developmental and behavioral pediatrics. A pediatrician in training can meet virtually with her once a month specialist team to discuss developmental and behavioral health issues assessment and care for children in need of support. They can take these recommendations back to the child and family and also learn about clinical management and care for children with developmental delays and disabilities. Guidance is also established.
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The Society for Developmental and Behavioral Pediatrics provides information on how pediatricians, providers, and families can advocate for the continued inclusion of a board-certified developmental and behavioral pediatrician in training programs. .
But health care systems and insurance companies must prioritize developmental and behavioral health by paying clinicians with this expertise higher salaries and reimbursements than we already receive. A healthy healthcare system should be advocated at the state level to increase reimbursement for the healthcare we provide. Giving children substandard treatment, ideally the best possible treatment, is unacceptable for cancer and inappropriate for developmental delays and disabilities. Our children are living longer than ever before, and both neurotypical and neurodivergent children are about to enter fruitful adulthood and, as they define it, to have a meaningful place in society. We are working hard to support you as much as possible.
This is an opinion and analysis article and the views expressed by the author or authors are not necessarily Scientific American.