Healthy body image is critical to adolescent development, and teens often diet and worry about their weight and appearance. However, for some youth these concerns become fixed and distorted, resulting in psychopathology. Eating disorders, particularly binge-eating disorder, anorexia nervosa, and bulimia nervosa, are serious, complex chronic disorders, which can be life-threatening. Differential diagnoses for eating disorders include: cardiac valvular disease, malabsorption syndromes; inflammatory bowel disease; chronic infections; thyroid disease; hypopituitarism, Addison disease; central nervous system lesions; cancer; and other psychiatric disorders including depression, obsessive-compulsive disorder, anxiety, and substance abuse. Eating disorders are difficult to treat, especially when presenting with comorbid diagnoses, and treatment depends on the severity of the illness. Primary health care providers play a critical role in assessment, monitoring of treatment progress, screening for and managing medical complications, and coordinating care with psychiatric and nutritional professionals.
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Pediatric primary care providers (P-PCPs) are involved in the primary care of children and adolescents with developmental and behavioral issues. The purpose of ongoing developmental behavioral screening in a primary care medical home is to identify problems early. These early interventions improve the long-term outcomes for children and adolescents. This chapter focuses on some of the more common neurological and psychiatric disorders that are encountered by children and adolescents in the primary care medical home setting and the ways in which the P-PCP can better identify a mental health disorder as early as possible through screening and intercept the problem with evidence-based interventions to promote better behavioral health outcomes. However, even with early intervention, some of the mental health disorders are chronic, long-term disorders requiring lifelong attention and treatment. It covers bipolar I disorder, depressive disorder, conduct disorder, obsessive-compulsive disorder, schizophrenia, and trauma- and stressor-related disorders.
The vast majority of lesbian, gay, bisexual and transgender children face similar developmental hurdles as their heterosexual and cisgender (non-transgender) peers, and grow up to be happy, healthy, resilient adults. However, research suggests that LGBTQ+ children also face a number of special challenges that may impact self-esteem, social–emotional development, behavioral risk taking, and mental and physical health. This chapter synthesizes available evidence to help identify and intercept issues related to sexual orientation and gender identity among children and adolescents and offers suggestions for caring for this increasingly visible, vulnerable, and wonderful population. LGBTQ+ youth face dual challenges—the expected developmental and social hurdles of childhood and adolescence combined with the struggles inherent in recognizing and accepting one’s sexual orientation and/or gender identity, including external and internal experiences of stigma and marginalization.
Infant depression has been studied as a phenomenon within psychology and psychiatry since the early 1970s. The Diagnostic and Statistical Manual for Mental Health Disorders (fifth edition; DSM-5) eliminated the terminology “disorders usually classified in infancy, childhood, and adolescence” and classified them as neurodevelopmental disorders removing infantile depression as a discrete condition. Pediatric primary care providers (P-PCPs) who provide care to infants need to be familiar with the best available evidence for recognizing signs of infantile depression to avoid missing the opportunity for early recognition of this problem. Recognizing the signs of infant and/or maternal depression affords the opportunity for P-PCPs to implement strategies to intercept negative emotional infant development to positive emotional outcomes. This chapter discusses research on infant depression, signs and symptoms of infantile depression, and provides strategies to enable mothers and other caregivers to actively engage the emotional development of infants throughout the first year of life.
Toddlers are unique individuals and appropriate developmental assessment is essential to their physical growth and well-being. Their social–emotional developmental issues can be the cause of behavior problems. Toddler behaviors are naturally impulsive and having temper tantrums is a hallmark of this age group. These behaviors can be a challenge for both first-time and seasoned parents. Parenting the always busy toddler requires understanding, patience, love, and attention from the caregivers on a daily basis. Toddlers can quickly vacillate between normal behaviors and abnormal behaviors. When parents are not prepared to manage these behaviors, the pediatric primary care provider (P-PCP) must often intercept the behaviors and provide workable interventions to the parents. This chapter offers support to parents and guardians, especially the mothers, to intercept potential parenting issues. The P-PCP can be the key to helping parents or caregivers successfully navigate this exhilarating but challenging time in their toddlers’ lives.
This chapter provides an overview of the assessment, diagnosis, and treatment of children and adolescents with a diagnosis of attention deficit hyperactivity disorder (ADHD). It presents common coexisting or comorbidities that are seen in children and adolescents with a diagnosis of ADHD. Early behavioral intervention may assist young children to learn self-management of actions before they might escalate to levels disrupting the child’s learning, peer interactions, and family life. When behavioral strategies are not effective or learning is compromised, stimulant medication becomes the gold standard of ADHD therapy, with the adjunct of behavioral therapy and/or disorder-targeted medications to mediate hyperactivity, mood, or negative outcomes. The child or adolescent with coexisting ADHD requires a team approach led by the pediatric primary care provider to include other medical and behavioral consultants, members from the child’s school to identify and diagnose coexisting disorders, and to establish an evidence-based, family-centered treatment plan.
The preschool child is generally 3 to 5 years of age. At 3 years old, the child is becoming a real person. The preschool years are an important time to prepare children to be successful in school. It is critical to identify and address the problem of social behavior readiness long before a child enters school. Parents need to be partners with other professionals in helping their children to succeed. They need to learn about their child’s growth and development and to be aware of unusual behavior changes and/or regressions to work with pediatric primary care providers (P-PCPs) to intercept potential behavioral problems. This chapter addresses the assessment, screening, diagnosis, and treatment of preschoolers with behavioral health problems. It also discusses assessing for school readiness and strategies to intercept potential and identified behavioral health problems in preschool-age children to help the child become ready to succeed in school.
This chapter provides an overview of behavioral issues in school settings. Major topics covers the explanations of why school settings can pose challenges for behavior; etiology, manifestations, and consequences of behavioral challenges in school settings; and bullying among children and youth as an example of a challenging behavior at school. The chapter discusses the behavioral problems with teachers and parents, it’s important for pediatric primary care providers (P-PCPs) to remember that descriptions of aggressive behaviors vary in severity, frequency, and seriousness of the acts themselves. Urge teachers and parents to observe and report the exact behaviors, their duration, possible catalysts, and impacts of the behaviors on the student, peers, and classroom learning. The chapter concludes with a summary of recommendations for P-PCPs who, with the correct knowledge about bullying behaviors, can intercept the problems while working with children who are affected by behavioral challenges at school.
The health and well-being of children, particularly vulnerable children, is one of the major national health priorities identified in Healthy People 2020. Pediatric primary care providers who are educated to screen, assess, diagnose, and treat children are mandated to report evidence of child maltreatment, neglect, and abuse. Intentional acts of maltreatment can impact the surviving child’s emotional, behavioral, and mental health throughout their life span. Children who are placed within the foster care system most often have experienced one or more of the following: abuse, neglect, maltreatment, and exposure to dysfunctional family life, including drugs, alcohol, domestic violence, and/or a parent remanded to jail. This chapter describes the current best available evidence for care of children in foster care, including the initial comprehensive physical and behavioral health assessments, screenings, and treatment plans, with a goal of identifying and intercepting permanent emotional trauma from the adverse effects from prior life experiences.
Ineffective child-rearing practices and poor parental attachments in the early years of life have the possibility of impairing a child’s physical, psychological, social, and emotional well-being. Although inadequate parenting has been linked to psychological issues with older children, few studies have investigated the negative effects ineffective bonding in the infant and toddler periods have on brain development. This chapter discusses the compelling outcomes of ineffective parenting and provides insights for assessing the parent–child relationship and interventions that may intercept behavioral disorders in children and adolescents as a direct result of ineffective parenting. Without appropriate interactions, children’s brains do not receive proper signals that allow for suitable neuronal development and connections, which can alter brain architecture. Therefore, early intervention is critical, as children and adolescents are more likely to develop negative psychological and physical symptoms in relation to toxic stress than adults.