developmental behavioral pediatrics vs. child psychiatry

[dl2dp2]

I was in a pediatric developemental clinic today, and realized that their practice is very much overlapping with child psychiatry. It's apparantly a 3-yr pediatric fellowship. Does anyone know about this? What's the difference? Is this due to a lack of child psych docs and the overflow of children with cognitive disabilities?

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[billypilgrim37]

I was in a pediatric developemental clinic today, and realized that their practice is very much overlapping with child psychiatry. It's apparantly a 3-yr pediatric fellowship. Does anyone know about this? What's the difference? Is this due to a lack of child psych docs and the overflow of children with cognitive disabilities?

I loved developmental pediatrics, and that rotation may have been the number one reason why I wanted to be a child psychiatrist. The limitation that the dev peds people have is that they simply do not have the training in psychopharmacology that child psychiatrists have, and do not feel comfortable prescribing atypicals and mood stabilizers the way a child psychiatrist will. They tend to work closely with child psychiatrists just for that reason.

Dev peds is a small field, and most of the jobs are either going to be academic or private pay, as insurance reimbursement does not cover the intensive time needed for the developmental peds skills to be employed. That means if you don't want to be academic, you better be satisfied working with the unfortunate children of rich people.

Either way, it's a cool, but relatively obscure field.

 

[Doc Samson]

Dev peds overlaps with CAP the same way behavioral neurology overlaps with adult psychiatry.

Dev peds sees a lot of autism, MR, and other developmental stuff in pretty much the same way behavioral neuro sees a lot of dementias and TBI. Psychiatry takes care of some of those folks but with a greater percentage of the primary psychiatric stuff.

 

[dl2dp2]

I was under the impression that child psychiatrists take care of ADHD/Autism kids, since the major ADHD/autism research centers tend to be in CAP departments, but I saw a couple in the dev peds clinic. There's also a bent towards learning disabilities/MR kids, which I'm assuming isn't necessarily under the purview of CAP. Is it because they don't usually prescribe atypicals such that these kids end up at a CAP clinic anyway? I've noticed a tendency to put more problematic autistic kids on atypicals. Seems like these pediatricians are very comfortable with stimulants. I'm guessing CAP also sees a lot of conduct disorder/ODD.

Yes it does seem very obscure and not that many pediatricians are interested in evaluating cognitive deficits in children. The visits are also way too drawn out to be profitable.

This field seems very wide open, and I'm assuming this is how CAP is like also in the short run. Various phenomenologies are classified under the rubric of "autism", but are completely heterogeneous--and these kids should really be in different sorts of remedial classes instead of having ONE "autism group." The other thing that kind of struck me today is the similarity between the concept of "constitutional short stature" and cognitive deficits. While we are very accepting of short kids when their parents are short, if kids are left behind in school when their parents are clearly not the brightest bulbs, everyone throws a hissy fit and these kids get put on meds. Thirdly, it seems the supposed cognitive enhancement is already happening for low-IQ children, since it seems like at least for some portion of that group, stimulants REALLY improve their cognitive performance.

Really fascinating field, but still currently very very underdeveloped clinically it seems.

 

[maranatha]

I was under the impression that child psychiatrists take care of ADHD/Autism kids, since the major ADHD/autism research centers tend to be in CAP departments, but I saw a couple in the dev peds clinic. There's also a bent towards learning disabilities/MR kids, which I'm assuming isn't necessarily under the purview of CAP. Is it because they don't usually prescribe atypicals such that these kids end up at a CAP clinic anyway? I've noticed a tendency to put more problematic autistic kids on atypicals. Seems like these pediatricians are very comfortable with stimulants. I'm guessing CAP also sees a lot of conduct disorder/ODD.


Really fascinating field, but still currently very very underdeveloped clinically it seems.

Yes, both C/A psych and behavioral pediatricians will see kids with Autism/MR/Developmental disorders. The difference is that we tend to deal more with the autistic/developmental kids with co-morbid psychiatric conditions while the behavioral pediatricians tends to deal with their basic medical needs. Some behavioral peds are more comfortable with the psych issues and will take care of that as well, however.

There can be a lot of overlap between the two fields in regards to autism and MR. They will also sometimes take patients with anxiety disorders and eating disorders. However, I doubt they have much training in psychosis and bipolar.

One major difference is also in therapy. With a psychiatry background we have much more exposure to the different therapeutic techniques and can incorporate therapy into our med visits. I think this is a major difference and is a perspective that would be sorely lacking in developmental peds.

 

[abc doc]

As a dbp fellow, I can say that I work closely with CAPs and we consult eachother all the time. Dbp sees more infant to toddler age ranges and we do a physical exam. We are trained more extensively in both ordering and analyzing genetic testing and metabolic workups than CAP. Since we see children so young, we are like detectives looking for syndromes that present at a young age. We diagnose a lot of nf-1, TS, FAS, Rett syndrome, anxiety, depression, adhd, cognitive disability, etc. We lead the downs, nicu follow-up, myelo/spinabifida, fragile x, and autism clinics.

We also attend cbt training, ados testing, behavioral family management training, and a multitude of neuropsych training. In my program we are trained how to manage antipsychotics, ssris, stimulants, alpha agonists, and mood stabilizers/neuroleptics. We refer to psych if they need inpatient admission of we feel uncomfortable with complex medical management.

It's a very young and interesting field. Advantages are that we do not admit patients. Even though our salary is at the lower end of the pediatric specialties, our demand is very high so we can virtually go anywhere and there is no inpatient responsibility. We charge consultation fees and insurance has been more accepting of our billing codes. If you like detective work, neurology without the seizure management, and psychiatry without the inpatient admissions this might be the specialty for you!

 

[digitlnoize]

Yes, lots of overlap. The big disadvantages to me are the age range (I prefer patients that can talk), the extra year of training (CAP is 5 vs 6 for dev peds), and it's easier to open your own office in child psych (less overhead, don't need exam rooms etc, more cash pay patients?)

 

[st2205]

Could always do triple board peds/psych/child psych then follow up with a 3 year developmental behavioral fellowship and let us know how it goes.

 

[hoodwinkd]

i happen to to LOVE both and could go on for days about them. in my experience, even though you do see much overlap, dev/beh peds will give better exposure to a younger population than the average child psychiatrist sees...we were aiming to catch and dx <2yo in dev/beh peds, esp within the ASD population and many intellectual impaired/learning disabilities/speech disorders where early diagnosis is of the essence

in terms of training, i felt dev/beh peds don't have the training to manage more difficult psych cases, which they often get esp ADHD, mood/anx d/os...i think because some families are more inclined to go see a "pediatrician" than a "psychiatrist". similarly, child psychiatrists don't have as much of a holistic, whole child approach as dev/beh peds (think the PE, genetics, therapies, etc.) i ultimately chose child psych but intend to practice more like a dev/beh peds as i have particular interest in working with Autism and young children with psych d/os. there are many paths you can explore, including triple boards programs, post peds portal programs, multiple fellowships...just depends on which would best fit your personal interest and how much time you're willing to dedicate to training. there's no wrong way!

 

[vistaril]

I was in a pediatric developemental clinic today, and realized that their practice is very much overlapping with child psychiatry. It's apparantly a 3-yr pediatric fellowship. Does anyone know about this? What's the difference? Is this due to a lack of child psych docs and the overflow of children with cognitive disabilities?

In my very brief experience working in such clinics, these people see/deal with a lot of pediatric problems that people with 2-3 months of peds their intern year wouldn't feel comfortable dealing with. At least on the few days I rotated through their clinic. IOW, to do what these couple of people did you would have had to develop the sort of skills one develops in a 3 year pediatrics residency first.