A note on interdisciplinary research in developmental/behavioral pediatrics/psychology

In sum, we have offered a few observations about the practice of interdisciplinary research. Now, in addition to our rather specific suggestions, we want to add a few general comments about the interactions of professionals who are actually involved in interdisciplinary research. Collaboration between physicians and psychologists can be enriching, stimulating, and rewarding. But it can also be problematic, because the former do not have much exposure to research and the latter do not have much exposure to clinical issues. Bringing these skills together may require many hours of discussion and reading each other's publications. Overall, physicians need to improve their research skills. Reading statistics texts, taking courses, handling data sets, reviewing other researchers' statistical designs are all reasonable strategies. Psychologists also need to expand their knowledge base. Reading the clinical literature is a start, but this ought to be supplemented by consistent exposure to the clinical milieu. The physician, who has access to the clinical milieu, needs to be sensitive to the question of exposure. Our final comments about collaboration are perhaps the most sensitive ones. The maintenance of a solid physician and psychologist research collaboration requires thoughtfulness, understanding, tact, and nurturance. Consider the status and responsibilities of the physician. He or she often outranks the psychologist, has access to the subject population, daily confronts ethical issues surrounding patient diagnoses, and controls communication of information to child and family. A sense of being in charge develops. Consequently, the psychologist may be perceived as being an adjunct to the research, responsible for day-to-day operations and committing ideas to paper.(ABSTRACT TRUNCATED AT 250 WORDS)     

A guide to critical reading of the literature in behavioral and developmental pediatrics.

The field of behavioral-developmental pediatrics covers a wide range of topics, problems, and conditions. A variety of professionals including pediatricians, psychologists, child psychiatrists, social workers, nurses, and educators are involved in research and clinical care. Each of these disciplines uses a variety of methodologies, each of which has its advantages and disadvantages. Different categories of research and methods of critiquing the literature in behavioral and developmental pediatrics are described.     

From neurons to neighborhoods: old and new challenges for developmental and behavioral pediatrics

Rapidly advancing research in neurobiology and the behavioral and social sciences, coupled with dramatic changes in the social and economic circumstances under which families are raising young children, has created a highly dynamic context for early childhood policy, service delivery, and child rearing in the United States. A recent report from the National Research Council and the Institute of Medicine, presents a critical analysis of that complex knowledge base and a set of recommendations designed to close the gap between what we know and what we do to promote the healthy development of young children. This article examines the report through the lens of developmental and behavioral pediatrics and highlights both exciting opportunities and sobering challenges.     

The meaning of measures: pitfalls in behavioral and developmental research.

This article considers a number of issues encountered in the selection and use of measures in research in the area of behavioral and developmental pediatrics. In addition to considering basic psychometric principles, it is argued that problems inherent in the developmental process, the lack of correspondence between study and standardization samples, and methodological factors affecting measurement may threaten the validity of individual measures and bias research outcome. A number of recommendations are made to counter the effects of these common measurement problems that indirectly result from the absence of a "gold standard" for measuring behavior and development.     

Toilet training in primary care: current practice and recommendations from behavioral pediatrics

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.     

A fork in the road: decision time for behavioral pediatrics.

The rapid growth of managed care, and especially that of managed behavioral healthcare organizations (MBHOs), is likely to diminish the role of developmental-behavioral pediatrics and separate care for medical and behavioral problems. Thus, a rethinking of the practice of developmental-behavioral pediatrics is required. This study reviews the structure of MBHOs, identifies barriers to the provision of services by developmental-behavioral pediatricians, describes alternative practice models for consideration, and makes recommendations. The aims of the recommendations are to stimulate an active discussion about these issues, spark an advocacy effort, and ensure the continued participation of developmental-behavioral pediatricians in the care of children with special needs. The study concludes that managed care will push developmental-behavioral pediatricians into integration with primary care group practices or into specialty mental health networks. Immediate discussion, action, and advocacy will be required to ensure a presence in these decisions for developmental-behavioral pediatricians.     

Mediator and moderator effects in developmental and behavioral pediatric research

The terms mediation and moderation are defined and clarified with particular emphasis on the role of mediational and moderational analyses in developmental and behavioral pediatric research. The article highlights the applicability of mediational and moderational analyses to longitudinal, intervention, and risk and protective factor research, and it provides basic information about how these analyses might be conducted. Also included is a discussion of various ways that both mediator and moderator variables can be incorporated into a single model. The article concludes with extended examples of both types of analyses using a longitudinal pediatric study for illustration. The article provides recommendations for applying mediational and moderational research in clinical practice.     

Training in developmental pediatrics. How practitioners perceive the gap.

Ninety-seven randomly selected, board-certified pediatricians in five New England states were interviewed by two physicians to explore attitudes toward previous training and current sources of knowledge in developmental pediatrics. Formal training in development was rated as inadequate by 79%, of residency experience was viewed as highly valuable by only 30%, and 47% rated medical school as having no value. Although clinical experience was reported as a valuable source of knowledge by 99% of the sample, almost two thirds did not regard it as an adequate substitute for formal training. Frequent interdisciplinary communication was reported, and professional contacts were described as a highly valuable ongoing source of knowledge. Social class and size of practice did not correlate with differences in consultation patterns. A part-time longitudinal clinical experience for further education was preferred by 97%. Improved training with greater interdisciplinary content is needed.     

Data analysis techniques in behavioral pediatrics: some practical advice.

A review of the last three volumes of the Journal of Developmental and Behavioral Pediatrics revealed that 27% of the articles used correlations, 17% chi 2, 16% t tests, 15% analysis of variance or covariance, and 13% involved regression analysis. Multivariate techniques, discriminant or factor analysis, logistic regression, and sensitivity/specificity were used in less than 5% of articles; the average number of statistical techniques per article was 2.5. These statistical techniques are described in general, conceptual terms in regard to appropriate and inappropriate usage. Clinical examples are provided. Familiarity with these techniques allows the reader "statistical access" to almost 90% of the articles in behavioral pediatrics and other areas of the medical literature.