Due to the longitudinal development of international developmental behavioral pediatrics, since the first edition of Developmental Behavioral Pediatrics came out in 1983, the book was reprinted in 1992, 1999 and 2009, respectively; meanwhile, another book, Developmental Behavioral Pediatrics – Evidence and Practice, was published in 2008; in 2011, by the American Academy of Pediatrics Developmental Behavioral Pediatrics was published, which means that developmental behavioral pediatrics has evolved from clinical practice to clinical evidence-based under the high priority and support of the Academy of Pediatrics.
Although developmental behavioral pediatrics is a newly established specialty, it has been in clinical practice for more than 30 years. In December 2011, the Developmental Behavior Group of the Pediatric Branch of the Chinese Medical Association held a national workshop for members of the Developmental Behavior Pediatrics Group in Shanghai, and one of the topics was the standardization of the application of terminology, which concerns the basic concepts of developmental behavior pediatrics and is an important and indispensable task in the construction of the discipline. Especially in recent years, some terms in the field of developmental pediatrics have been confused in the application process, and some terms have changed with the development of the discipline, so the standardization of the application of some basic terms is particularly important.
I. Basic terms of developmental behavior pediatrics
1. behavioralvariation: There are obvious individual differences in the development of children’s behavior, which is manifested by different temperaments and influenced by genetics, brain maturation and environment. Child health science has elaborated on child development, developmental behavior pediatrics is based on the developmental process, combined with the individual personality, temperament, ability, physiological state of the ecosystem; family environment, cultural and social influences, parenting practices, etc., to view the diversity of child behavior.
2.Developmental delay (developmentaldelay): Development is a rate phenomenon. The rate of child development can be stable, but the behavior displayed is changing over time. The developmental energy areas of young children include gross motor, fine motor, language, and social adaptation skills. Each of these skills has a specific developmental progression. Developmental delay is defined as a significant lag in the developmental process and generally refers to delays in all functional areas. The developmentalquotient (DQ) is now used to indicate the degree of delay. When the infant DQ≤80, children with this degree of delay should have a second interval of testing; when the infant DQ≤60 in any 1 energy area, there should be a comprehensive assessment; and when the infant DQ≤50 in any 1 energy area, it is easier to find a specific organic cause.
Developmental dissociation: Developmental dissociation reflects the difference in developmental rate when comparing two developmental energy areas, one of which is significantly lagging behind. For example, in children with language disorders, language development significantly lags behind motor development, and in children with communication disorders and pervasive developmental disorders, language skills significantly lag behind visual-motor skills. Developmental dissociation is most often seen in older children with learning disabilities. They often have normal intelligence and low academic performance. The developmental phenomena revealed by the different developmental disorders are shown in Table 1.
Table 1 Developmental segregation in children with various developmental disorders
Disorders
Motor
Problem-solving skills
Language
Social/adaptive
Gross Motor
Fine Motor
Expression
Sensory
Intellectual disability
Normal/Abnormal
Normal/abnormal
Delay
Delayed
Delayed
Delayed
Cerebral palsy
Delayed
Delayed
Normal/abnormal
Normal/abnormal
Normal/abnormal
Delayed
Autism
Normal
Normal
Normal/Abnormal
Delayed
Delayed
Normal/Abnormal
Language impairment
Normal
Normal
Normal
Delay
Normal/abnormal
Normal
Learning Disability
Normal
Normal/Abnormal
Normal/Abnormal
Normal/Abnormal
Normal/Abnormal
normal/abnormal
4.Developmental deviation (developmentaldeviancy/deviation): Developmental deviation refers to the extraordinary developmental order of certain developmental energy regions, often the more difficult developmental ability precedes the easier developmental ability. The difference between developmental deviation and developmental segregation is that the former is an anomaly in the developmental order of one energy region that is more difficult than the other, whereas the latter is a difference in the developmental rate of two energy regions compared to each other, where one energy region is significantly better than the other. For example, a child with autism may have a vocabulary of 50 words (which a normal child has at 24 months of age), but does not know the meaning of father and mother (which a normal child has at 10 months of age) and consistently uses echolalia; children with communication disorders, pervasive developmental disorder, Williams syndrome, and hydrocephalus, for example, exhibit imitative language despite having a vocabulary above their age level. Despite having a vocabulary above their age level, children with pervasive developmental disorder, Williams syndrome, and hydrocephalus show imitative language expressions without the intention of active communication.
5. range (spectrum): range refers to the severity of the developmental behavior disorder and is divided into 3 levels: mild, moderate, and severe. In clinical practice, developmental behavior disorders are diagnosed using the Capute and Accardo model, which integrates 3 aspects of development, which include motor, cognitive, and social behavior, and are represented by the 3 sides of a triangle (Figure 1).
Developmental behavior disorders have a clinical range in terms of severity, i.e., they vary in severity. Examples of gross motor disorders are developmental dysfunction and developmental coordination disorder in mild cases and cerebral palsy in severe cases; fine motor disorders are dysgraphia in mild cases and cerebral palsy in severe cases; and oral motor disorders are phonological dysarthria and salivation in mild cases and dysarthria and dysphagia in severe cases; cognitive disorders are poor learning in mild cases (IQ 80-89), borderline intelligence in moderate cases (IQ 70-79), and intellectual disability in severe cases ( IQ<70); social behavior disorder is withdrawal and communication problems in mild cases, social infantile behavior in moderate cases, and lack of social communication in severe cases.
6, holistic (continuuum): holistic refers to the developmental behavior disorder mostly involves 3 aspects namely motor, cognitive and social behavior impairment. The impairment of one of these aspects will generally be accompanied or co-morbid with the deficits of the other two aspects. Therefore, a holistic concept is required for clinical assessment and diagnosis. A particular disorder can have varying degrees of motor, cognitive, and social behavioral impairment. For example, about 50% of children with cerebral palsy may have cognitive impairment, and conversely about 25% of children with intellectual disability have cerebral palsy. If we look at the developmental behavior of children with cerebral palsy in a holistic concept, the deficits are mainly in the motor area with mild cognitive function and social behavioral backwardness (Figure 2); another example is children with intellectual disability, whose deficits are mainly in the cognitive and social behavioral area (Figure 3); another example is children with communication disorders, whose deficits are mainly in the social behavioral area with mild cognitive developmental backwardness (Figure 4). .
Changes in the terminology of developmental behavioral disorders
Nowadays, the American Psychiatric Association has changed the terminology of mentalretardation to intelledtualdisability mainly because of the individual potential and human nature. In 2000, the American Psychiatric Association defined mental retardation with three criteria.
(1) A marked deficit in intellectual functioning;
② Significant limitations in at least 2 areas of adaptive functioning, including communication, self-care, furnished living, social/interpersonal communication skills, use of community resources, self-direction, functional learning skills, work, recreation, health and safety;
(iii) Must have occurred before the age of 18 years. The diagnosis of intellectual disability is often made for children over the age of 3 years. This is because developmental tests under 3 years of age lack good predictive effect, and many of the tests assess mainly sensory-motor skills in young children.
The above is the consensus reached by the Developmental Behavior Group of the Pediatrics Branch of the Chinese Medical Association at the National Developmental Behavior Pediatrics Group members’ seminar on terminology study in Shanghai, and we hope to share it with our colleagues from all related professions and hope to receive valuable corrections and suggestions.