Curriculum standards
Curriculum standards
Completion requirements
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Advanced Training in Community Child Health
Knowledge guides
LG11: Developmental and behavioural paediatrics
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Atypical development. Loss of, or acquisition of, developmental skills which is differentiated from neurotypical development:
- autism spectrum disorder
- neurodegenerative conditions
- response to trauma
- Behavioural and social impairments
- Behavioural complexity:
- aggression/irritability
- anxiety
- disruptive behaviours
- functional difficulty
- mood
- pica
- repetitive behaviours
- self-injurious behaviours
- social challenges
- Child abuse and neglect
- Concerns from school/learning difficulties
- Crises and changes in families
- Developmental disability
- Developmental variance
- Elimination disorders
- Externalising behaviours (disruptive behaviour disorders):
- ADHD combined type
- conduct disorders
- ODD
- Family dysfunction
- Feeding and eating problems
- Gender health
- Global developmental delays - delay across several domains:
- cognitive
- language
- Intellectual disability/cognitive impairments
- Internalising behaviours:
- ADHD-I
- anxiety
- mood disorders
- Isolated developmental impairments/delay:
- fine motor impairment
- isolated speech and language delay
- Sexuality
- Sleep issues
- Social and language impairments:
- autism spectrum disorder
- expressive language delay
- selective mutism
- Somatic symptoms such as chronic pain
- Substance use
- Temperamental variation
Conditions
- ADHD
- Autism spectrum disorder
- Cerebral palsy
- Communication disorders
- Co-morbid mental health conditions:
- anxiety disorder
- conduct disorder
- eating disorders
- gender dysphoria
- mood disorder
- obsessive compulsive disorder
- oppositional defiance disorder
- tics/Tourette syndrome
- Fetal alcohol spectrum disorder (FASD)
- Global developmental delay
- Intellectual disability
- Motor disorders, such as developmental coordination disorder
- Selective mutism
- Sensory impairments:
- hearing impairment
- sensory processing disorder
- vision impairment
- Specific learning disabilities
- Syndromic conditions associated with developmental delay/presentations:
- Di-George syndrome
- Down syndrome
- NF1
- Sotos
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation and identification of any functional difficulties
- understand the interplay and overlap of many neurodevelopmental and behavioural conditions
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical and biopsychosocial history, including relevant collateral history
- conduct an appropriate examination and developmental assessment
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- plan out intervention, surveillance, and management of a child
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
- ongoing understanding of management and monitoring and assessment of emerging conditions/conditions
- conduct acute risk and safety assessment (mental health, child safety, acute illness)
Consider other factors
- identify individual and psychosocial factors and the impact of these on diagnosis and management
- understand the trajectory of the conditions and long-term impacts
Conditions
- Acquired injuries to the central nervous system
- Common genetic conditions affecting development
- Congenital malformations of the nervous system
- Neuromuscular disorders
- Pre- and perinatal insults and exposures
- Toxin exposures
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation and identification of any functional difficulties
- understand the interplay and overlap of many neurodevelopmental and behavioural conditions
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical and biopsychosocial history, including relevant collateral history
- conduct an appropriate examination and developmental assessment
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- plan out intervention, surveillance, and management of a child
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
- ongoing understanding of management and monitoring and assessment of emerging conditions/conditions
- conduct acute risk and safety assessment (mental health, child safety, acute illness)
Consider other factors
- identify individual and psychosocial factors and the impact of these on diagnosis and management
- understand the trajectory of the conditions and long-term impacts
Atypical development
- Behavioural red flags with problems related to:
- delayed or disordered play
- delayed language
- difficulties with transition
- emotional dysregulation
- inconsistent motor coordination
- lack of imaginary play and facial expression
- not pointing or turning to name
- poor eye contact
- poor socialisation
- problems with social or emotional reciprocity
- repetitive or unusual behaviours
- sensory processing difficulties
- Common co-morbidities
- Cumulative risk for children experiencing adverse events from within a vulnerable population
- Risk factors for atypical development, including:
- factors during childhood impacting on development, such as:
- chronic disease
- deprivation
- family environment
- postnatal depression and other maternal mental health concerns
- sensory impairment
- trauma
- perinatal factors impacting on childhood development, such as:
- birth asphyxia
- prematurity
- prenatal, such as:
- adverse in-utero environment
- chromosomal
- substance use in pregnancy:
- ethyl alcohol
- smoking
- stressful life events
- factors during childhood impacting on development, such as:
- The impact of developmental trauma on neurobiology as described in the work by Bruce Perry
Development
- Attachment theory and the impact of disordered attachment on child development
- Critical periods in development
- Factors affecting development, such as:
- community provisions
- critical or sensitive periods
- family
- genetic
- health
- interplay of genetics and environment
- nutrition
- plasticity
- positive influences on outcomes:
- health
- nurture
- nutrition
- stimulation
- pre- and perinatal
- Functional capacity of infants, children, and young people at different stages of development, including cognitive, emotional, and social capacities
- Key developmental concepts, such as:
- attachment
- neuroplasticity
- resilience
- temperament
- theory of mind
- Impact of social and individual factors on developmental trajectory and their implications for practice through an ecological framework and the biopsychosocial model of health and development
- Influence of biological embedding of early life experience or experience-based brain development on subsequent health and development
- The concept of developmental trajectory
- Typical development:
- developmental milestones:
- Bayley
- Gesell
- Griffiths
- Sheridan
- expected variations in nature and sequence of developmental milestones
- key elements of theories of development
- developmental milestones:
- Stages of social and emotional development, such as:
- Erikson
Assessment tools/instruments
- Adaptive function assessment:
- Adaptive Behaviour Assessment System (ABAS-3)
- Developmental and Behavioural checklist (DBC-2)
- Vinelands Adaptive Behaviour Scales
- Autism specific tools, such as:
- 3di
- ADIR
- Autism Diagnostic Observation Schedule (ADOS)
- Childhood Autism Rating Scale (CARS)
- Development assessment tools:
- Bayley scales of Infant Development
- Griffiths scales of Mental Development (Griffiths III)
- Development screening tools, such as:
- Autism Detection in Early Childhood (ADEC)
- ASQs
- GMA
- HINE
- Learn the Signs
- MCHAT-R
- Schedule of Growing skills
- SCQ
- SNAP-IV
- symbolic play test
- FASD neurocognitive assessments
- Interpretation of:
- psychometric assessment tools completed by psychologists, such as:
- non-verbal tests
- WISC
- WPPS
- office based vision and hearing screening, such as:
- audiometer use
- LEA charts
- tympanometry
- those used by allied health professionals, such as:
- assessment of cognition and academic skills
- sensory profile
- speech assessment
- use of and interpretation of growth charts
- psychometric assessment tools completed by psychologists, such as:
- Interview tools, such as:
- Autism Diagnostic Interview-Revised (ADI-R)
- Narrow based and broad-based instruments, such as:
- Achenbach Child Behaviour Checklist (CBCL)
- Conners system:
- CBRS
- Conners 4
- Conners EC
- SNAP-IV
- Vanderbilt
Classification systems
- Diagnostic:
- Diagnostic and Statistical Manual of Mental Disorders (DSM)
- International Classification of Disease (ICD)
- Functional:
- World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF)
Interventions
- Office-based physician interventions, including:
- catalytic: asking questions to encourage fresh thinking
- cathartic: facilitating the expression of emotions and fears
- confronting: challenging another’s thinking
- informative: helping others gain a better understanding
- prescriptive: providing direct management advice
- supportive: valuing contributions
- Specific techniques, such as:
- behaviour management:
- ABC model
- emotion coaching approaches as described by Gottman and Dan Siegal
- Functional Behavioural Assessment Framework
- brief, solution-focused approaches
- cognitive behavioural therapy
- early intervention:
- occupational therapy
- physiotherapy
- psychology
- social work supports
- speech therapy
- motivational interviewing
- serve and return
- systemic family counselling
- trauma informed interventions
- behaviour management:
Investigations
- Developmental screening blood tests
- Genetic bloods, such as:
- cGH array
- Fragile X
- MECP-2
- WES
- Neurological:
- EEG
- MRI
- Sensory investigations, such as:
- hearing
- vision
- Bias involved in tools self-completed versus those completed by others
- Community supports available, including local networks and agencies
- Development of gender and sexuality
- Developmental red flags for assessment around:
- chronic pain
- dysmorphic features
- growth differences
- neurological concerns
- regression
- risk of harm
- sleep impairments
- Developmentally appropriate level of involvement of children and young people in their own care
- Difference between screening and assessment tools, and the limitations of each
- Effects of psychosocial factors on access to care
- Ethical issues in prescribing to children, including the implications of off label prescribing
- Factors that support resilience and optimal child wellbeing
- Fail to attend/be brought to appointment
- Family understanding of, response to, and coping with disability
- Impact of the education sector on infant, child and youth development and wellbeing
- Impacts, negative or therapeutic, that a child’s environment can have on their wellbeing
- Importance of considering the child as an individual, with unique strengths and challenges
- Importance of provision of family-centred care
- Importance of teaching parents, children, and young people to understand and manage their own issues
- Managing difficult to access children and young people
- Neurodevelopmental comorbidities
- Strategies to manage questionable, complementary or alternative practices
- Temperament and its implication for health and development across childhood and adolescence
Management
- Medication (pharmacological) management:
- alpha agonists, such as:
- clonidine guanfacine
- antipsychotics, such as:
- aripiprazole
- risperidone
- dexamphetamine-based psychostimulants
- melatonin
- methylphenidate-based psychostimulants
- non-stimulants, such as atomoxetine
- psychotropics
- SNRIs
- SSRIs
- alpha agonists, such as:
- Non-pharmacological management
- Referrals and interagency collaboration
- allied health therapy
- education
- funding
- further assessment