We are most pleased to present Volume 3 of Developmental-Behavioral Disorders: Selected Topics, designed to serve as a companion for standard reference textbooks that address cogent issues in developmental pedi atrics. Periodic publications such as Selected Topics and theme-related articles, as well as continuing education programs, attempt to supple ment in a timely fashion the rapidly changing knowledge base in devel opmental-behavioral pediatrics. These media are important as forums for enhancing the quality of clinical practice, teaching skills, and re search activities. The need is critical for periodically disseminating and updating information about issues in developmental medicine, in as much as this field of study continues to expand at a meteoric pace. During the past several decades, developmental medicine has been recognized as a defined subspecialty in pediatrics. The spectrum of problems encompassed by this discipline is relatively broad and at times clinically overwhelming. The ultimate goal of preventing delays, disor ders, and/or dysfunctions from becoming chronic handicapping condi tions has, by volume per se, created clinical dilemmas for pediatric health care providers. There are numerous facets of providing efficient and effective care, which in the field of developmental-behavioral pediatrics are often exaggerated impediments to the delivery of services by pri mary health care specialists, e. g., time, clinical skills, need for inter disciplinary management, medical-legal responsibilities, financial reim bursements. These issues, as well as clinical problems, are still very much part of the information base to be disseminated to concerned pro fessionals."

"Child development" has always been a traditional component of well child care and a particular area of interest for pediatricians, child neu rologists, and psychologists. However, it was not until the early 1960s that children with developmental disabilities (i. e. , chronic handicapping disorders) became a major focus of public and professional attention. During this period, children with "special needs" were dramatically catapulted into the limelight and "exceptional" became the buzzword of the day. Public and professional awareness of these issues reached new peaks and recognition of the potential psychosocial impairments of chil dren with developmental disabilities created national anxiety. A variety of factors contributed to an unprecedented societal advocacy for chil dren with developmental problems: (1) a national concern generated by President Kennedy'S particular interest in mental retardation; (2) in creased activity and visibility of parent advocacy/lobbying groups (e. g. , the Association for Children with Learning Disabilities); (3) the enact ment of federal legislation designed to protect the rights of the handi capped (e. g. , PL94-142); and (4) the popularization of developmental behavioral disabilities by the various communications media. Cumulatively these events precipitated a redefinition of the real mean ing of "comprehensive health care for children," resulting in an empha sis on the child's neurodevelopmental, educational, psychological, and social needs. For the pediatrician, a myriad of new management respon sibilities were mandated, in addition to the traditional health care con cerns.

Child/adolescent development and behavior have been a traditional "concern" of prima ry health care providers. However, it was not until the mid-1960s that attempts were made to consolidate developmental-behavioral issues into an identifiably distinct fund of medi cal knowledge. During the ensuing two decades, developmental-behavioral pediatrics was recognized as a clinical and research subspecialty, within the framework of compre hensive health care for children. The influence of public advocacy groups, topic-dedicated journals, national professional specialty societies, subject-related continuing education programs, and federal legislation (PL94-142) has served to crystallize developmen tal-behavioral pediatrics as a specialized field of study. As a consequence, during the past ten years significant modifications have restructured medical student and pediatric resi dent education, providing an emphasis on developmental-behavioral issues. The focus on neurodevelopmental, educational, and psychosocial issues reflects changing priorities in traditional health care for children. The postgraduate training of pediatric fellows, in two and three-year training programs, was initiated to accommodate professional manpower needs in both academic and practice settings. Many of the problems in childhood development and behavior frequently span the traditional areas of child neurology, child psychiatry, and general pediatrics. As a result there has been some confusion in demarcating professional responsibilities in diagnosis and management, as well as poorly defined terminology and classification schemas. With the birth of developmental pediatrics as a pediatric specialty, a more cohesive fund of knowledge has been accumulated and more meaningful strategies have been designed for prevention, diagnosis, and management."

Topics presented include: the role of autorelaxation and mental imagery in developmental pediatrics; graduates of the neonatal intensive care unit; self-destructive behaviors in children and adolescents; office screening for communication disorders; child and adolescent depression; television's impa

I. Introduction: General Issues in Developmental Disorders.- 1 State of the World's Children: Developmental-Behavioral Disorders in a Global Context.- 1. Introduction.- 2. Children in History.- 3. Children Today.- 4. Recent Nutrition Data.- 5. Children Tomorrow.- 6. Conclusions.- References.- 2 PL 99-457: A New Challenge and Responsibility for Physicians.- 1. Introduction.- 2. Physician Involvement.- 2.1. Identification.- 2.2. Medical Evaluation.- 2.3. Communication with the IFSP Team.- 2.4. Family Support.- 2.5. Participation in the IFSP Process.- 2.6. Advocacy.- 3. Barriers to Physician Involvement.- 4. Overcoming Barriers.- Selected Readings.- 3 An Ethical Issue in Developmental Pediatrics: Analysis and Discussion of a Case History.- Case History-S. L., a Newborn with Partial Trisomy-13.- Reference.- Selected Readings: Ethical-Legal Issues.- 4 A Physician's Primer of Developmental and Psychologic Test Instruments.- 1. Introduction.- 2. Possible Developmental Delay.- 2.1. Developmental (Cognitive/Motor) Delay.- 2.2. Language Delay.- 2.3. Behavioral/Adaptive Delays.- 3. Cases Involving Suspected Developmental Delay.- 4. Difficulties in School Performance.- 4.1. Intelligence.- 4.2. Academic Achievement.- 4.3. Perceptual/Visual Motor.- 4.4. Attention/Concentration.- 4.5. Behavioral.- 5. Cases Involving Suspected School Problems.- 6. Conclusions.- References.- II. Developmental Disorders.- 5 Neonatal Brain Care: Does Early Developmental Intervention Work?.- 1. Introduction.- 2. Supplemental Stimulation.- 3. Protection at All Costs.- 4. Contingency-Based and Developmentally-Based Interventions.- 5. Summary.- References.- 6 Early Identification of Cerebral Palsy.- 1. Introduction.- 2. Types of Cerebral Palsy.- 3. Early Clinical Signs of Cerebral Palsy.- 3.1. Amiel-Tison et al. (1977).- 3.2. Ellenberg and Nelson (1981).- 3.3. Harris (1987).- 3.4. Research Conclusions.- 4. Summary.- References.- 7 Movement Disorders and Paroxysmal Behaviors in Children and Adolescents.- 1. Introduction.- 2. Disorders Characterized by Alteration in the State of Consciousness and Abnormal Movements.- 2.1. Seizure Disorders.- 2.2. Pseudoseizures.- 3. Disorders Characterized Primarily by an Alteration in Consciousness.- 3.1. Syncope Due to Inadequate Cerebral.- 3.2. Postural Hypotension.- 3.3. Steal Syndromes.- 3.4. Cardiac Arrhythmias.- 3.5. Breath Holding Spells.- 3.6. Syncope Due to Hypoxia or Hypoglycemia.- 4. Disorders Characterized Primarily by Abnormal Movements.- 4.1. Disorders Characterized by Hyperkinesia.- 4.2. Disorders Characterized Primarily by Abnormalities of Posture and Tone.- 4.3. Disorders Characterized Primarily by Akinesia.- 5. Other Paroxysmal Disorders.- 5.1. Rett Syndrome.- 5.2. Mannerisms.- References.- 8 Epilepsy: Implications for Intelligence, Learning, and Behavior.- 1. Introduction.- 2. Epilepsy and Intelligence.- 3. Epilepsy and Learning Difficulties.- 4. Epilepsy and Childhood Emotional and Behavioral Disorders.- 4.1. Anticonvulsants and Behavior Disorders.- 4.2. Temporal Lobe Epilepsy and Psychiatric Disorders.- 5. Summary.- References.- 9 Learning Disabilities: "The Good News/The Bad News".- 1. Introduction.- 2. Toward a Definition.- 3. Significant Discrepancy.- 4. Research.- 5. The Future.- References.- 10 Lessons I've Learned from Learning Disabilities.- 1. Introduction.- 2. Overlooked Learning Disability.- 2.1. Emotional Disturbance and Underachievement.- 2.2. Headaches and Fatigue.- 3. Miscellaneous Lessons I Have Learned.- 3.1. "Abnormal Depth Perception" in a Clumsy Child.- 3.2. Involuntary Movements with Accompanying Behavioral Upset.- 3.3. Refusal to Speak in an Anxious Child.- 3.4. Cerebral Palsy with Accompanying Depression.- 3.5. Newly Acquired Perceptual Disorder in an Intelligent Child.- 3.6. Situational Depression with a Well-Controlled Seizure Disorder.- 3.7. Acute Psychosis with Temporal Lobe Epilepsy.- 3.8. Declining School Performance and the Misdiagnosis of Seizures.- 3.9. Adolescent Stroke with Com...