Behavioral Pediatrics in Primary Care
-the application of behavioral analysis and developmental psychology to child behavioral problems presenting in primary care settings
Behavioral Pediatrics in Primary Care-Major Emphasis
-prevention over cure/rehab
Two Types of Intervention in Bxal Pediatrics
- Supportive Health Education
2. Prescriptive Treatment
Three Domains of Care in Bxa’ Pediatrics
- Common Behavior Problems
- Behavior problems with significant medical (biological) dimensions
- Medical (biological) problems with significant behavioral dimensions
Definition of Prescriptive Treatment
-when we provide tx for bx already occuring
Common Bx Problems Presenting in Primary Care
- high frequency/low intensity problems
- responsive to prescriptive bxal treatments
- approx. 50% of all primary care child visits involve behavior problems
Common behavior problems are not pathologies…
they are skill deficits (parents are ‘on their own’)
Common parenting tactics for pediatric behavior problems..
-ignoring, warning, yelling, spanking, rewarding, reasoning, placating, or indulging
What is the rule of thirds?
1/3 of pediatric bxal problems get better
1/3 get worse (our population)
1/3 manage
Skinner’s vision for behavior analysis…
has yet to be fully realized
What is the major emphasis in behavioral pediatrics?
-prevention
What are the two types of intervention in behavioral pediatrics?
- (supportive) health education
- prescriptive treatment
Dr Friman supplied a list of the top behavior problems in 3 year old children and then argued that parents were pretty much on their own when solving them. Why?
the problems are not pathologies in 3 yos
Info on the gap in Behavioral Health Care for Children:
- primary care pediatrics on one side
- conventional mental health services for children on the other
- vast range of behavioral health problems in the gap
Why might pediatricians not address common behavior problems?
- limited or no time
- limited or no training
- lack of inclination
Why are parents reluctant to seek mental health services for children?
- Over-interpretation in practice:
a. underlying problem syndrome
b. Berkson’s bias: emphasis on highly impaired populations
c. Textbook case bias: emphasis on extreme cases - Research Practices: Correlative theory building over intervention
- Public Impressions: not flattering
- highly variable quality in mental health services
Common behavior problems in three year olds are typically the result of:
skill deficits
Sample Health Education topics in Behavioral Pediatrics in primary care:
- learning
- crying
- sleep
- toilet readiness
Children learn through repetition with
contrast in experience
2 types of change in Clarifying Contrast
- Quality
2. Quantity
Quality of Clarifying Contrast
- determines direction of learning
1. Pleasant
a. reward (positive reinforcement)
b. relief (negative reinforcement)
2. Unpleasant
a. pain (positive punishment)
b. loss (negative punishment)
Quantity of Clarifying Contrast
- determines need for repetition
1. Large-large change, less repetition
2. Small-small change, more repetition
This determines direction of learning
quality of the consequence
This determines the need for repetition
quantity of the consequence
