ABP Developmental-Behavioral Pediatrics cheat sheet

Gross motor sequence: head control by 3-4 months, rolling 4-6 months, sitting unsupported 6-8 months, crawling 8-10 months, standing with support 9-10 months, independent walking 12-15 months.

Language sequence: cooing around 2 months, babbling around 6 months, canonical babbling 7-10 months, first words around 12 months, 50-word vocabulary by 18 months, two-word phrases by 18-24 months.

Refer for language evaluation if there is no babbling by 12 months, no single words by 16 months, no two-word phrases by 24 months, or any loss of language skills.

Growth rule: term birth weight doubles by about 5 months and triples by 12 months; length increases about 50% by 12 months; head circumference increases about 12 cm in the first year.

Red flags: persistent hand preference before 18 months, asymmetric movement, toe walking after 5 years, developmental regression, no social smile by 3 months, and failure to respond to sound.

Social-emotional sequence: social smile 6-8 weeks, stranger anxiety 6-9 months, separation anxiety 9-18 months, parallel play 2-3 years, cooperative play around 4 years.

Piaget milestones: object permanence 8-12 months, symbolic play 18-24 months, conservation around 7 years; these guide cognitive expectations but are not diagnostic thresholds.

Global developmental delay means significant delay in two or more domains in a child under 5 years; it warrants hearing evaluation, etiologic workup, and early intervention referral.

A fall across two or more major growth centiles, or a head circumference crossing centiles rapidly, is a growth red flag requiring evaluation.

ADHD: for children under 17 years, at least 6 inattentive or hyperactive-impulsive symptoms; for age 17 and older, at least 5 symptoms; several symptoms before age 12; present in 2 or more settings; clear impairment.

Major depressive episode: at least 2 weeks of depressed or irritable mood or anhedonia plus 4 additional symptoms; irritability is common in children; assess suicide risk.

Oppositional defiant disorder: angry-irritable mood, argumentative-defiant behavior, or vindictiveness lasting at least 6 months and causing impairment; distinguish from developmentally normal oppositionality.

Conduct disorder: a repetitive pattern violating basic rights of others or major age-appropriate norms, including aggression, property destruction, deceit or theft, and serious rule violations.

Separation anxiety disorder: developmentally inappropriate, persistent fear of separation from attachment figures lasting at least 4 weeks in children and causing significant impairment.

PTSD: exposure to trauma plus intrusion, avoidance, negative cognition or mood, and arousal symptoms lasting more than 1 month and causing impairment.

OCD: obsessions or compulsions that are time-consuming, cause distress, or impair functioning; insight varies with age; comorbid tics and anxiety are common.

Tic disorders: provisional tic disorder if tics last less than 1 year; persistent tic disorder if motor or vocal tics last more than 1 year; Tourette disorder requires both motor and vocal tics for more than 1 year.

Enuresis: repeated voiding into bed or clothes at least twice weekly for 3 months or clinically significant distress in a child at least 5 years old; encopresis requires age at least 4 years and often involves constipation.

Autism spectrum disorder: persistent deficits in social communication and social interaction plus restricted, repetitive patterns of behavior, interests, or activities; symptoms begin early and cause impairment.

Intellectual disability: deficits in intellectual functioning, such as reasoning or problem-solving, and deficits in adaptive functioning with onset during the developmental period.

Cerebral palsy: nonprogressive motor impairment from early brain injury or malformation; classify by tone, distribution, and Gross Motor Function Classification System level; screen for seizures, vision, hearing, and feeding problems.

Down syndrome: usually trisomy 21; screen for congenital heart disease, hearing loss, hypothyroidism, obstructive sleep apnea, and atlantoaxial instability; monitor growth on syndrome-specific charts.

Fragile X syndrome: FMR1 CGG repeat expansion above 200 causes intellectual disability, autism features, macroorchidism, long face, prominent ears, and anxiety; premutation carriers have distinct risks.

Rett syndrome: usually MECP2 variant in girls; early regression, loss of hand use, hand stereotypies, impaired communication, gait abnormalities, and seizures.

Tuberous sclerosis complex: TSC1 or TSC2 variants cause hamartomas, ash-leaf spots, seizures, developmental delay, and autism; surveillance includes brain, kidney, skin, and lung evaluation.

Duchenne muscular dystrophy: X-linked dystrophinopathy in boys; progressive proximal weakness, Gowers sign, elevated creatine kinase, calf pseudohypertrophy, and cardiomyopathy; consider steroid therapy.

Fetal alcohol spectrum disorder: prenatal alcohol exposure with sentinel facial features, growth deficiency, and central nervous system abnormalities; diagnosis requires a multidisciplinary assessment.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value = true positives / all positive results; it rises with higher prevalence, so screening performance differs between low-risk and high-risk populations.

Developmental screening is recommended at 9, 18, and 30 months; autism-specific screening is recommended at 18 and 24 months using a validated parent-report tool.

M-CHAT-R scoring: total 0-2 is low risk; 3-7 is medium risk and requires the follow-up interview; 8-20 is high risk and warrants immediate referral for evaluation.

A diagnostic evaluation for developmental delay includes hearing and vision testing, developmental history, physical and neurologic examination, and standardized cognitive and adaptive measures.

Intellectual disability requires both low intellectual functioning, typically about 2 standard deviations below the mean, and adaptive behavior deficits; neither alone is sufficient.

First-tier etiologic testing for global developmental delay may include chromosomal microarray, fragile X testing, thyroid studies, lead level, and metabolic testing; brain MRI is guided by findings.

Children under 3 with developmental delay or established risk qualify for IDEA Part C early intervention; children 3 and older may qualify for IDEA Part B special education services.

Screening tools are not diagnostic; a positive screen requires diagnostic assessment, and a negative screen does not override clear clinical concern.

IDEA Part C: early intervention from birth through age 2, using an Individualized Family Service Plan; IDEA Part B preschool special education begins at age 3 and uses an Individualized Education Program.

Section 504 provides accommodations for a disability that substantially limits a major life activity but does not require special education; it is distinct from an IEP.

ADHD: for children under 6, behavioral parent training and environmental supports are first-line; for children 6 and older, medication plus behavioral treatment is recommended.

Pediatric anxiety: cognitive behavioral therapy is first-line; selective serotonin reuptake inhibitors are considered when therapy is insufficient or unavailable, with monitoring for activation and suicidality.

Pediatric depression: psychotherapy such as cognitive behavioral therapy or interpersonal therapy is first-line; fluoxetine is approved for ages 8 and older; monitor suicide risk closely.

Autism intervention: intensive behavioral and developmental approaches, speech-language therapy, occupational therapy, and parent-mediated strategies target communication, adaptive skills, and behavior.

Cerebral palsy management: multidisciplinary therapy, spasticity management, nutrition and feeding support, seizure treatment, and orthopedic surveillance; the underlying brain injury is nonprogressive.

Care coordination: the medical home should link families to early intervention, school services, specialty care, respite, and insurance or Medicaid programs such as EPSDT.

Transition planning: begin discussion of health, education, and vocational transition in early adolescence, with formal school transition planning by about age 14-16 depending on state requirements.