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1. 23/03/2016
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DEVELOPMENTAL AND
BEHAVIORAL PEDIATRICS
PHAM MINH TRIET, M.D, M.P.H, M.C.P
Head of Psychology Department
trietpm@nhidong.org.vn
BACKGROUND
• DEVELOPMENT
• BEHAVIOR
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: introduction
• Five major streams: motor, language, visual-
motor (cognitive), adaptive, and social.
• Abnormal development in one stream  the
risk for abnormality in another  a careful
assessment of all streams.
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: introduction
• Developmental diagnosis is a functional
description and classification and does not
specify an etiology or medical diagnosis.
• When development is not progressing
normally, the pattern of abnormal development
may include delay, deviancy, dissociation
and/or regression.
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: definitions
1. Developmental Quotient (DQ): rate of
development.
• DQ of one stream = (Developmental
Age/Chronologic Age) × 100
• Ex: a boy begins running at 18 months of age 
DQ of motor = (15/18) x 100 = 83.33%.
• Ex: a girl begins talking at 18 months of age 
DQ of language = (12/18) x 100 = 66.67%.
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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Developmental
Age
From
milestones
From tests
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: definitions
2. Delay: DQ < 70 in a given area of skill. May
occur in a single stream or several streams.
3. Deviancy: uncustomary sequence of milestone
attainment within a single stream of
development.
4. Dissociation: indicates differing rates of
development among developmental streams.
5. Regression: loss of previously achieved
milestones
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: examples
Patient 1
100%
60%
85%
62%
55%
0%
20%
40%
60%
80%
100%
120%
Motor Language Cognitive Adaptive Social
Stream
delay
disociation
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: examples
Deviancy:
Ex: walking without crawling, singing songs but
unable to converse, counting or speaking English
but unable to converse.
Regression:
Ex: speaking 2 words – sentence at 20 months of
age; then, at 24 months: unable to speak any
word.
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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CHILDREN'S HOSPITAL 1
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70%
40%
68%
62%
45%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Motor Language Cognitive Adaptive Social
DEVELOPMENT: examples
Mental retardation + suspected autismPHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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DEVELOPMENT: management
Problems solving
• Special education with individual program
–Autism: social communication & attention
• Unexpected behaviors: psychology treatment
 drugs
• Language/speech therapy
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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BACKGROUND
• DEVELOPMENT
• BEHAVIOR
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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BEHAVIORS: basic assessment
• Which behavior?
• When?
• Where?
• Who?
• How often? How much?
• What: event? Reduces? Increases?
 Simple or complex behavior?
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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Simple or complex behavior?
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CHILDREN'S HOSPITAL 1
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BEHAVIORS: management
• Simple  simple management
• Complex  diseases? Or psychology
problems?
• Diseases  Pediatrics Symptom
Checklist – 17 (or 35): Mood disorders
(anxiety, depression, bipolar disorder),
ADHD/ADD, Conduct disorder,
Oppositional Defiant Disorder + Obsessive
Compulsive Disorder
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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BEHAVIORS: management
Diseases: mild, moderate or severe?
• Mild: psychology management
• Moderate: drugs + psychology management
• Severe: drugs
Psychology problems?  psychology
management
• Event before symptoms occurred
• Relationships of patient: home, school and
community PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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COMMON DISEASES/DISORDERS
1.Speech and Language Development and
Disorders
2.Autism Spectrum Disorders
3.Learning Disabilities
4.Attention-Deficit/Hyperactivity Disorder
5.Disruptive Behavior Disorders: Conduct
disorder, Oppositional Defiant Disorders
6.Anxiety, Depression
7.Obsessive Compulsive Disorder
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CHILDREN'S HOSPITAL 1
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REFERENCES:
1. The Harriet Lane Handbook 20th
edition
2. Developmental and Behavioral
Pediatrics 2011
THANKS FOR YOUR ATTENTION
PHAM MINH TRIET, MD
CHILDREN'S HOSPITAL 1
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