Fall 1998
Articles
Reviews
1998 Award Recipients
1997 Award Recipients
Special Presentation
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From the Chair
by William Lord Coleman, M.D.
FAAP, Chapel Hill, NC
The struggle for sub-certification and the opposition we face
Subcertification for Developmental Pediatricians continues to be a major focus. We
have the endorsement by the American Board of Pediatrics. The American Academy of
Pediatrics has also endorsed our proposal, and we finally had a hearing by the American
Board of Medical Specialties (see related articles in this issue). Still, we continue to
face strong opposition from our colleagues in Child and Adolescent Psychiatry in spite of
years of constructive and warm working relationships that many of us had developed.
The following is an excerpt from an article by David Pruitt, M.D., President of the
American Academy of Child and Adolescent Psychiatry, a national organization with 6,500
members. This article is from the American Academy of Child and Adolescent Psychiatry
Newsletter, May 1998.
Comments made by Dr. Pruitt for the public hearing at the American
Board of Medical Specialties Meeting, Chicago, IL, March 18, 1998.
"Child and adolescent psychiatry is a specialty which serves kids with
emotional and behavioral problems, disorders and mental illnesses. A core part of the
knowledge base of our specialty is normal growth and development. We have expertise in
areas of normality, normal variation, problems and disordered functioning of children,
adolescents and families. As managed care grows, and as this country’s desire to
adequately serve all children grows, child and adolescent psychiatry has modified and will
continue to modify how we serve our patients and how we relate to our colleagues. We in
the Academy are committed to finding solutions to the growing needs for serving all
children.
"Many of the 6,500 Academy members work closely and collaboratively with
pediatricians and pediatric systems, and particularly with those pediatricians who have a
special interest in emotional and behavioral issues of childhood. We respect our medical
colleagues, and particularly those 400 plus pediatricians who pursue this application
today. Many of them are friends and all are respected colleagues.
"Today the Academy finds it necessary to take a position of strong opposition to
the application submitted concerning Developmental-Behavioral Pediatrics.
"We in the Academy think acceptance of this application will confuse medical and
mental health colleagues and students, and as importantly, the public in general about the
roles and responsibilities in the clinical and training area of child and adolescent
mental health and illness. American Board of Medical Specialties Bylaw 10.3 was adopted
and reaffirmed to prevent such confusion. Bylaw 10.3 makes good medical sense as well as
good sense about roles and functions, definitions, and responsibilities. The Bylaw strives
for clarity in communication to the public and helps avoid overlap and costly duplication
of medical responsibility.
"We in the Academy think this application is unnecessary. It will add the expense
of another overlap of specialty for both training and billing. A viable training option
already exists through the triple board training, and the experience of 5 rather than 6
years of training. Adding an extra year will actually lose the option of one board
eligibility.
"Finally, we in the Academy are concerned that the acceptance of this application
will, through duplication, lessen training in the psycho-social needs of children and
through confusion, weaken the collective chance for all kids to receive the adequate
mental health care that they need and deserve. The many problems highlighted in the DBP
Application exist, but the solution, as presented in this application, is false and it
damages the integrity of child and adolescent psychiatry training and clinical care.
"A more effective approach is to better use the 7,000 child psychiatrists in this
country to help deliver mental health training and care to pediatric trainees and patients
rather than forming a new sub-specialty.
"Once again, we look forward to working with all of medical colleagues to find
better solutions to serve better kids."
This statement by Dr. Pruitt is based on misinformation and spoken out of ignorance of
the real differences between psychiatry and developmental-behavioral pediatrics. The only
explanation for this aggressive position is political and financial defensiveness. It is
apparent to all pediatricians and child psychiatrists (who I greatly admire and work with
closely) that there are more children with a variety of
emotional-behavioral-developmental-social problems (and they are all often intertwined)
than either pediatricians or psychiatrists can handle alone. Also we see kids with
different problems, different levels of severity, and we have a different perspective
(contextual, developmental, social) and do not rely mainly on DSM-IV diagnoses and
psychopharmacological treatments.
Developmental-Behavioral pediatrics must become a certified sub-specialty to better
serve the vast numbers of children we see and to better train future sub-specialists and
help generalist pediatricians. Better service, research, teaching, and training, not
duplication, will be the result.
I urge Section members to read the excellent article on the unique nature of
behavioral-developmental pediatrics and the justification for our sub-specialty proposal.
The article is written by Forrest Bennett M.D. FAAP, and is in the June issue of Contemporary
Pediatrics. In fact, the content of this newsletter serves to differentiate us from
psychiatrists and neurologists.
American Academy of Pediatrics Task Force on the Family.
The AAP has formed the Task Force on the Family. Edward Schor, M.D. is the chair and
members include Drs. Marilyn Billingsly, Alma Golden, Julia McMillan, Linda Meloy and Ben
Pendarvis. The consultants are Drs. William L. Coleman, Barbara J. Howard, and Donald
Wertlieb (Ph.D.). The purpose of this two-year task force is to develop policies and
clinical practice approaches to better help the pediatrician appreciate the importance of
the family to the total well being of children. The family is the most central and
enduring influence on a child, and the family context is the domain of pediatricians.
The directives of the Task Force on the Family:
To analyze the social science and medical literature to quantify the nature of those
factors that strengthen the family’s ability to nurture children.
To develop materials to enable Academy members to teach parenting skills to families
in their practices, and assist residency programs in developing health education curricula
that support teaching about optimal family function in a culturally sensitive manner.
To guide the Academy in the development of federal and state legislative policy that
is family friendly and promotes and supports maintenance of two-parent households,
including changes in tax policy, welfare and other social `service services policies that
may now encourage family dissolution.
To guide the Academy in the development of policy to help pediatricians provide
guidance to single parent households in support of the children.
To undertake a careful review of existing Academy policies relative to their impact
on family and family function, making recommendations to committees and the board of
directors with respect to policy modification based on data, development and analysis.
The AAP Task Force on the Family is yet another example of what distinguishes general
pediatricians and developmental-behavioral specialists from psychiatrists and
neurologists. It is yet more evidence for the justification of our sub-certification for
Developmental-Behavioral pediatrics.
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