From the Chair
William Lord Coleman, M.D.
Chapel Hill, NC

I would like to share some thoughts and readings.

The Journal of Developmental and Behavioral Pediatrics (June 1997) has a very informative series of commentaries on the new Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent version. It also contains a very good book review of the DSM-PC. The DSM-PC (edited by Mark Wolraich, Marianne Felice and Dennis Drotar) is an extremely important document. It represents an advance in the diagnostic codification of a variety of emotional, behavioral and developmental problems. It also serves as an excellent educational "textbook" for medical students, residents and practitioners.

The Archives of Pediatrics and Adolescent Medicine (August 1997) contains an excellent editorial and two articles on spanking. Corporal punishment remains a national problem and controversial topic.

Pediatric journals are publishing more articles on developmental and behavioral pediatrics and related topics. However many other publications offer topics related to developmental-behavioral pediatrics. The journal "The Family Therapy Networker" is published six times per year. The March/April and July/August 1997 issues have cover articles dealing with relevant pediatric topics: "resiliency" and "learning from our clients." They are well-written, informative and very useful.

Alternative medicine is receiving more and more press and airtime. Contemporary Pediatrics (August 1997) offers an informative article on alternative medicine.

"Behavior: Ask the Experts" is a recent and welcome addition to the Journal of Contemporary Pediatrics. The clinical vignettes and questions sent in by practitioners are challenging, and cover the range of developmental and behavioral issues in all ages. Send questions to:

Advocacy is a pediatric "specialty." Pediatricians can advocate for children with learning problems by informing parents about their children’s rights to a free evaluation and possible supportive school-based services under a variety of Federal laws. I would suggest that a pediatrician speak with a school psychologist, educational diagnostician or another developmental-behavioral pediatrician who is experienced in learning disabilities and working with schools. I mention this because I recently gave a talk at a conference in which a pediatrician from New York who had been in practice for 25 years told me he had never heard of the Federal laws which he could use to gain support for children.

Dr. Julius Richmond, one of the great stalwarts and advocates for developmental and behavioral pediatrics, was a lead off witness in a class action suit in which airline attendants were suing the tobacco companies about the harmful effects of passive smoking in airplanes. Dr. Richmond wrote a report on the harmful effects of smoking when he was Surgeon General and Assistant Secretary of Health under President Carter. Steady pressure does make a difference. The agreement that the tobacco companies have proposed to the government and the disappearance of Joe Camel advertisements are examples of what pressure can do and how children can be helped through this method. Keep lobbying your Congress members.

The Agency for Health Care Policy and Research announced that researchers applying for funds cannot restrict their studies to adult services, but must address children’s issues wherever they are relevant.

The movement toward sub-certification status for developmental and behavioral pediatrics is inching forward. Our Section is actively backing the proposal submitted to the American Board of Pediatrics by the Society for Developmental and Behavioral Pediatrics.

"An Idea Whose Time Has Arrived" is an article by Dr. Julius Richmond published in Pediatric Clinics of North America in August 1975. Dr. Richmond pointed out the differences between child psychiatry and developmental and behavioral pediatrics and made a very persuasive argument as to why there is room and need for developmental and behavioral pediatrics as a separate sub-specialty. Twenty-two years after this article, we are still working toward this goal and are making progress.

Lucy Crain, M.D., FAAP has resigned from the Executive Committee of our Section. Lucy is going to devote more time to regional AAP matters. We will miss her and we appreciate her efforts. Drs. Teplin and Lansford are running for her vacant seat. Please be sure to vote when you receive the ballot from the AAP.

Congratulations Jackie! Jackie Bucko, our hard-working and very effective Section Liaison , was recently married Her new name is Jackie Burke. Her new assistant is Chelsea Dixon (800-433-9016 ext. 7087).

"Sports Physicals Should Screen for Risk Behaviors." A letter in Contemporary Pediatrics (August 1997) by Patricia Levenberg, R.N., Ph.D., PNP (GAPS Project Coordinator in Chicago Illinois) is worth quoting. She suggests a comprehensive screen for health risk behaviors and associated health guidance is needed to make the most of a sports camp or school physical. "More attention must be devoted to prevention of the four causes of 72% of all deaths among school age youth and young adults in America: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Recommendations from the American Medical Association’s "Guidelines for Adolescent Preventive Services" (GAPS) and the Maternal-Child Health Bureau’s "Bright Futures" suggest that early detection of health risk behaviors, immunizations and reinforcing health promotion and prevention messages that adolescents received in schools, families and other parts of the community are key components of adolescent health care. Accepting the challenge to expand the pre-participation sports examination to include screening, brief office interventions, and health guidance can be an effective and rewarding experience for the pediatrician and potentially life-saving for the adolescent."

"The Power of Parents" is the title of an editorial in Contemporary Pediatrics (August 1997) by Dr. Julia McMillian. She emphasizes how important it is to consider the family situation in which a child lives and to respond appropriately to problems and strengths within the parents themselves. She concludes "as pediatricians we cannot ensure that every child is brought up in a loving home free of violence and indifference. But because we know how fragile families can be, we can cherish and support the parents who use their power over their children to provide support, encouragement, and love. It is our legal responsibility to identify parents who do wrong toward their children. It is our privilege to recognize and honor those parents who do right."

Pediatricians and school health. In June in a two day conference conducted by the AAP Committee on School Health and the Section on school health, approximately 60 pediatricians learned how to improve their skills in sports medicine, substance abuse treatment and prevention, emergency care. In addition, they learned about communicating with teachers and school boards, contracting for school health consultation, drafting school policies, and working with managed care organizations to improve school health services. The conference was part of the AAP Comprehensive School Health-Capacity and Policy Initiative funded by the Centers for Disease Control and Prevention through a sub-contract with the American Medical Association. The end point is to provide pediatricians with tools and resources to help them work with schools and community groups and participate in health services and education. For more information on AAP School Health Initiatives or on chapter based school health training programs in your chapter, contact Scott Allen, AAP Division of Child and Adolescent Health, 800-433-9016, ext. 7396.

"Where Children Rule" is the title of an article in the New York Times Sunday Magazine (August 17, 1997). The subtitle reads: "Why are Japan’s primary schools better than ours? Students lead classes. They even clean the bathrooms. Everything they learn they teach themselves." Japanese students are more likely to say they enjoy school than are American students, especially in the elementary school years. Japanese elementary pupils spend more time in school than their American counterparts but they also enjoy far more breaks and recesses. The classrooms are often marked by "cheerful chaos", "but what the teachers are trying to teach is not so much discipline as self-discipline."

They are remarkably tolerant of misbehavior and even open defiance. Japanese elementary schools build an enormous sense of community, in part by usually keeping the same class together for two years, with the same students and often with the same teacher as well. They do it by putting students in charge. Teachers are not the bosses in Japanese classrooms, at least not in the way they are in the United States. When students make mistakes, the teachers do not correct the error; they leave that to other students. The teachers do not punish students who misbehave; rather they manipulate other students to scold the culprit into feeling guilty. It is this manipulation that is a key to primary and pre-school education in Japan, and the teachers are the most masterful manipulators imaginable.

Beginning in the earliest grades, children take on responsibilities. Starting in the first grade, the students bring lunch from the school kitchen to the classroom, serving it to everyone and then cleaning up afterward. The children also rotate among themselves the job of class monitor, responsible for calling the class to order, calling the role, and discussing any class matters. The idea is that this teaches leadership and perhaps just as important followship, for it inevitably creates some empathy for the plight of the person trying to calm an excited class.

Children are involved in setting expectations and goals for the class period. Class meetings are a regular activity in which goals are discussed and methods to help everyone work together more effectively. Students are given responsibility not just in extracurricular activities but in lessons as well. When a teacher asks a question, hands shoot up and the teacher calls on the student. If the student makes a mistake, another pupil will correct him or her and then the teacher will invite the students to debate the issue.

A problem or question, for example a math problem, is written on the board. Children break into small groups and work on the answer collectively. Children take turns in leading class discussions in how the problems were solved.

Values are emphasized and discussed frequently. Working hard, being active, being cheerful, friendly, and helpful are desired goals and are actively discussed, encouraged and acknowledged through discussions, posters, and slogans. Parents and teachers are united in helping children develop and maintain these values. Japanese parents set very high standards and push their children to achieve these idealized behaviors and goals.

Keeping students in class longer develops a sense of community as well as their academic skills. By the end of the 6^th grade, the average Japanese or Chinese child has had more than an extra year of instruction compared with an American child. Summer vacations are frequently only 6 weeks long and students often have homework to complete during summer vacation.

Japanese teachers seem to be very well trained, respected, and see themselves as professionals. 99 percent of Japanese children attend public elementary school and there is far less difference than in America between schools in rich and poor areas. Teachers are also paid very well, often earning salaries that are generally higher than those of pharmacists or engineers. In a typical year there are 5 applicants for every teaching job.

Japanese elementary schools nurture the enthusiasm and creativity that the Junior High Schools later tend to destroy. The image of the overworked, stressed, older Japanese student is not the image of the elementary school child. Basic skills, empathy, a work ethic, a sense of community, and positive attitudes toward learning are formed in the elementary years. We might have something to learn from the Japanese about teaching elementary school children and raising children.

The Annual Meeting in New Orleans will be informative, enjoyable and practical. I hope you plan to attend our Section’s educational sessions on Sunday November 2^nd. The Aldrich and Dale Richmond Awards will be presented to Drs. William Harris and Morris Wessel respectively.

9/13/97

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