Preschool development. Part 2: Psychosocial/behavioral development.

Abstract

1. Raymond A. Sturner, MD* 2. Barbara J. Howard, MD† 1. 2. *Associate Professor of Pediatrics, Director of Behavioral Pediatrics Fellowship Training Program. Drs Sturner and Howard are Codirectors of The Center for Promotion of Child Development Through Primary Care, Millersville, MD, and serve on the pediatric staff of the Patuxent Medical Group in Annapolis, MD. Dr Sturner is the author of the START test and owns the patent on the Communication Screening System. 3. 4. †Assistant Professor of Pediatrics, The Johns Hopkins University School of Medicine, Division of General Pediatrics, Baltimore, MD. Dr Howard is a content consultant for edutainment videotapes for children and parents. 1. Assessment of psychosocial and behavioral milestones during health supervision visits requires consideration of both child temperament and parental style. 2. Problem behaviors often occur when the child’s need for independent functioning, mastery, or self-identity conflicts with parental attitudes and expectations. 3. The clinician should be able to categorize parental concerns about psychosocial issues into “developmental variation,”“ problem,” or “disorder,” using the definitions provided by the DSM-PC . 4. The high continuity of aggressive and oppositional behavior from preschool to later years mandates preventive interventions for preschoolers. 5. Child health supervision that features discussion of one or two key issues based on a clinical hypothesis of each individual child/family’s developmental trajectory may be of greater value to families than recitation of generic advice about multiple topics. During the preschool years, children are rapidly developing patterns of behavior and psychosocial skills that can be long-lasting. Clinicians have important opportunities to monitor and help shape optimal development when seeing preschool children for their health supervision visits. This is the second of a two-part article discussing the development of the preschool child from the point of view of the clinician who is conducting a visit using Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents . Both articles are organized by the“ trigger questions” suggested for visits at ages 2, 3, 4, and 5 years of age. The trigger questions regarding psychosocial and behavioral aspects of the child’s development are reviewed here; the first article ( Pediatrics in Review September 1997) focused on the “more traditional” developmental areas of communication and motor development. Any dichotomy between behavior and development is murky because behavioral issues often are uncovered when reviewing areas traditionally called development, and behavior can be interpreted only in light of the child’s level of developmental functioning. Research indicates that emotions and cognition are interconnected in …