Dr. Neal Rojas, a developmental and behavioral pediatrician from Developmental Medicine Clinic at UCSF graciously came Jennifer Katz, Inc. and spoke to our team of speech language pathologists. He presented an overview of his role as a developmental pediatrician at UCSF and answered all of our questions with clarity and humor. Dr. Rojas is a huge advocate for early identification and treatment of speech and language disorders. As he said, “the earlier we identify it, the more we can do about it”.

A general pediatrician is responsible for the overall care and health of children. They compare the child’s physical, mental, social and behavioral characteristics to the norm and are also responsible for identifying red flags or what is commonly referred to as developmental delays or atypical characteristics or actions.

A developmental-behavioral pediatrician is a subspecialist within the practice of pediatric medicine. This subspecialty remains interdisciplinary integrating Psychology, Pediatrics and related disciplines (Carey, Crocker, 2009).

Developmental-behavioral pediatricians specialize in the diagnosis, treatment and management of children, adolescents and their families with developmental and behavioral conditions. Examples of these conditions are the following (AAP, 2011):

• Learning disorders including dyslexia, writing difficulties, math disorders, and other school-related learning problems;
• Disorders that deal with behavior and attention spans including Attention-Deficit Hyperactivity Disorder (ADHD) and associated conditions including oppositional-defiant behavior, conduct problems, depression, and anxiety disorders;
• Habit disorders such as Tourette’s Syndrome;
• Regulatory disorders including sleep disorders, problems in feeding, discipline difficulties, complicated toilet-training issues, enuresis (bedwetting), and encopresis (soiling);
• Developmental disabilities such as cerebral palsy, spina bifida, mental retardation, Autism Spectrum Disorders (ASD), and visual and hearing impairments;
• Developmental delays in speech, language, motor skills, and cognitive ability.

Recommendations of general pediatricians who do possess a certification in Developmental-Behavioral Pediatrics but are nevertheless vastly knowledgeable in dealing with Autism Spectrum Disorders, are still valid. However, in more complex cases that necessitate the expertise of professionals aptly trained in the diagnosis and treatment of such conditions, Developmental-Behavioral Pediatricians are called in.

A developmental assessment varies by setting but at UCSF, Dr. Rojas typically spends about an hour with the child and then a few weeks later will have an appointment with just the parents/caregivers. Prior to the initial assessment, the parents and teachers (if applicable) will complete detailed questionnaires.

He talked about when to refer and while there is no definite one answer fits all – he shared the following ‘red flags’:

• Safety
• Not getting along with others
• Learning
• Self-Esteem

Dr. Rojas talked about the concept of mental energy and gave the description of “stepping on the gas” – sometimes we might get too much of a response and other times we might not get enough of a response. This is a learned behavior that children with attentional problems have a hard time with. He also shared the analogy of a “filter” or “strainer” in which for these children often either too much information gets in and other times not enough.