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The Time and Practice Challenges of Developmental-Behavioral Pediatrics: An Australian National Study

Roberts, Gehan MB, BS, FRACP, PhD, MPH*†‡; Efron, Daryl MB, BS, FRACP, MD*†‡; Price, Anna BA(Hons)*†; Hiscock, Harriet MB, BS, FRACP, MD, Grad Dip Epi*†‡; Wake, Melissa MB, BS, FRACP, MD, Grad Dip Epi*†‡

Journal of Developmental & Behavioral Pediatrics: June 2011 - Volume 32 - Issue 5 - p 368-374
doi: 10.1097/DBP.0b013e31821bd07e
Original Article

Objective: Developmental/behavioral diagnoses are common in pediatric practice but, until the impact on pediatricians of caring for these children is quantified, training and remuneration barriers are unlikely to be addressed. In a prospective audit of Australian office-based pediatricians, developmental-behavioral and medical consultations were examined regarding (1) consultation characteristics, (2) child and parent health, and (3) referrals and investigations ordered.

Methods: In 2008, all 300 eligible members of the nationwide Australian Paediatric Research Network were invited to prospectively record standardized information for every consultation over 2 weeks or 100 consecutive patients, whichever came first. After coding all diagnoses, consultations were classified as developmental/behavioral, medical, or “mixed.” These groups were compared using simple 3-group comparisons (Aims 1 and 2) and logistic regression (Aim 3).

Results: One hundred ninety-nine (66%) pediatricians recorded 15,360 diagnoses for 8,335 consultations (34% developmental/behavioral, 48% medical, and 18% mixed). Compared with medical patients, developmental/behavioral patients were older, more likely to be male, and required on average ∼9 minutes more time per consultation; self-reported parent health was worse; and referrals were more common (odds ratio 2.2, 95% confidence interval 1.9 to 2.5; p < .0001), but investigations less common (odds ratio 0.4, 95% confidence interval 0.3 to 0.4; p < .0001). Child health was worst in the “mixed” group.

Conclusion: Developmental/behavioral consultations are common in pediatric office settings. They are time-consuming, often lead to referrals, and the worse health reported by their parents may pose additional challenges. Pediatric training and funding models must address these barriers if adequate and comprehensive care is to be accorded to these complex patients.


From the *Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia; †Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; ‡Department of Pediatrics, The University of Melbourne, Victoria, Australia.

A commentary related to this article entitled “Strengthening the Capacity and Effectiveness of Developmental and Behavioral Services: Implications from Australia” by Paul H. Dworkin, MD can be found in this issue on page 402.

This article has supplementary material on the Web site:

Received October 2010; accepted January 2011.

The Australian Paediatric Research Network is funded by the Murdoch Childrens Research Institute and by the Paediatric and Child Health Division of the Royal Australasian College of Physicians. Dr Roberts is supported by NHMRC Health Professional Research Fellowship 607384, Professor Wake by NHMRC Career Development Award 546405, and Dr Hiscock by NHMRC Career Development Award 607351 and Capacity Building Grant 436914.

Address for reprints: Dr Gehan Roberts, Centre for Community Child Health, Royal Children's Hospital Melbourne, Flemington Road, Parkville, Victoria, Australia 3052; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.