Marvin I. Gottlieb - Böcker

"Child development" has always been a traditional component of well­ child care and a particular area of interest for pediatricians, child neu­ rologists, and psychologists. However, it was not until the early 1960s that children with developmental disabilities (i. e. , chronic handicapping disorders) became a major focus of public and professional attention. During this period, children with "special needs" were dramatically catapulted into the limelight and "exceptional" became the buzzword of the day. Public and professional awareness of these issues reached new peaks and recognition of the potential psychosocial impairments of chil­ dren with developmental disabilities created national anxiety. A variety of factors contributed to an unprecedented societal advocacy for chil­ dren with developmental problems: (1) a national concern generated by President Kennedy'S particular interest in mental retardation; (2) in­ creased activity and visibility of parent advocacy/lobbying groups (e. g. , the Association for Children with Learning Disabilities); (3) the enact­ ment of federal legislation designed to protect the rights of the handi­ capped (e. g. , PL94-142); and (4) the popularization of developmental­ behavioral disabilities by the various communications media. Cumulatively these events precipitated a redefinition of the real mean­ ing of "comprehensive health care for children," resulting in an empha­ sis on the child's neurodevelopmental, educational, psychological, and social needs. For the pediatrician, a myriad of new management respon­ sibilities were mandated, in addition to the traditional health care con­ cerns.

Child/adolescent development and behavior have been a traditional "concern" of prima­ ry health care providers. However, it was not until the mid-1960s that attempts were made to consolidate developmental-behavioral issues into an identifiably distinct fund of medi­ cal knowledge. During the ensuing two decades, developmental-behavioral pediatrics was recognized as a clinical and research subspecialty, within the framework of compre­ hensive health care for children. The influence of public advocacy groups, topic-dedicated journals, national professional specialty societies, subject-related continuing education programs, and federal legislation (PL94-142) has served to crystallize developmen­ tal-behavioral pediatrics as a specialized field of study. As a consequence, during the past ten years significant modifications have restructured medical student and pediatric resi­ dent education, providing an emphasis on developmental-behavioral issues. The focus on neurodevelopmental, educational, and psychosocial issues reflects changing priorities in traditional health care for children. The postgraduate training of pediatric fellows, in two­ and three-year training programs, was initiated to accommodate professional manpower needs in both academic and practice settings. Many of the problems in childhood development and behavior frequently span the traditional areas of child neurology, child psychiatry, and general pediatrics. As a result there has been some confusion in demarcating professional responsibilities in diagnosis and management, as well as poorly defined terminology and classification schemas. With the birth of developmental pediatrics as a pediatric specialty, a more cohesive fund of knowledge has been accumulated and more meaningful strategies have beendesigned for prevention, diagnosis, and management.