“We are grateful for changes in the practice of many clinicians who work with individuals with differences, providing care and support that facilitate participation and celebrate individuality.”

Developmental behavioral pediatrics (DBP) evolved over the past 50 years from a specialty that was established to educate pediatricians on the variations of normal neurodevelopment and behavior to a specialty that, in addition to understanding the broad spectrum of change in developmental and behavior, now includes diagnostic techniques and therapeutic strategies in learning disorders, mental health conditions, and behaviors that affect function at home, school, and in the neighborhood. In addition, studies in neuroscience, psychiatry, psychology, and sociology have informed clinicians in ways that have brought a sharper understanding to the progress of child development.

The senior author of the first edition of DBP, Dr. William Carey, was a general pediatrician whose practice was informed by a deep understanding of childhood temperament that continues as a significant legacy in the fifth edition. Scientific knowledge and clinical applications are readily available to primary care pediatricians, nurse practitioners, family physicians, and DBP specialists. In addition, speech and language therapists, physical and occupational therapists, behavioral therapists as well as child psychologists, and child psychiatrists can benefit from the many clinically useful insights throughout the book. The quote from the book's authors (above) attests to the multidisciplinary perspective.

DBP-5 is multiauthored, guided by 5 distinguished clinicians representing DBP, Child Psychology, and Family Medicine. The first section begins with a discussion of the biopsychosocial model of child development, the foundation of pediatric practice. Theories of human development through the life span are followed by theories of learning and behavior change. These theoretical constructs are elaborated and supported throughout the text. The following 3 sections support the biopsychosocial frame of reference: Life Stages (from the maternal-fetal dyad to adulthood and end of life), Social and Environmental Contexts of Children (e.g., family systems, parenting, foster care and adoption, trauma and resilience, and the influence of digital media on children and families), and Biological Factors, Medical Conditions, and Exposures Affecting Development and Behavior.

The writing in DBP-5 is influenced by the Covid-19 pandemic. Commentaries in several chapters include the implications of Covid-19 on child and adolescent development, learning, behavior, and family function. Virtual pediatric visits, a feature in contemporary practice, are addressed in several chapters. How infants and young children understand race and racism is illustrated effectively in a compelling diagram. Racial bias in health care settings and health disparities are addressed with guidance for early recognition and response. The sections on environmental and biological influences on health are expanded and updated to include more information on parenting, adverse childhood experiences, toxic stress, genetics, and brain injury.

The Section on Assessment and Management begins with interviewing and the physical examination. Attention to precise language and clear writing lead to numerous clinical pearls for both beginning and advanced readers. Although some DBP clinicians rely on the interview, direct observations, questionnaires, and psychological testing, the value of a full physical examination is supported by the potential to reveal subtle or previously missed findings, modeling for the caregiver approaches to calmness and cooperation, and the opportunity for an emotional connection with the child. Tables to delineate objective measurements for temperament, school readiness, educational testing, and cognition, adaptive function, all with accompanying narratives, are comprehensive and up to date. The chapter on neuroimaging compares ultrasound, computerized tomography, and magnetic resonance imaging. Reading the chapter was a terrific learning experience.

Uncertainty and ambiguity about a behavioral diagnosis, often limited by the absence of a biological marker, affects parents and clinicians. The final chapter in this section discusses implications of uncertainty and the process of shared decision-making.

Primary care clinicians and developmental behavioral pediatricians frequently ask, “Should I initiate behavioral therapy for this patient, or should I refer to a specialist?” The section on management and treatment guides the reader to an informed response. Beginning with a guide to assessing readiness for changing behavior, the principles and practice of behavioral parent training, applied behavioral analysis, lifestyle interventions, play therapy, interpersonal therapy, and family systems therapy are accessible to the generalist and the specialist. The discussion on motivational interview is the most beneficial narrative I have read, accompanied by tables that elucidate realistic conversations with patients.

There is sufficient information on each modality to inform clinicians on their application during the initial phase of treatment and then decide whether there is a need for a referral as well as consider more training in a particular therapy. Cognitive behavioral therapy is effectively demystified to provide clinicians with the tools to engage patients in this evidenced-based intervention. A lucid description of trauma-informed care includes applications in clinical settings.

Additional chapters I found valuable with innovative recommendations are early intervention, transition to adulthood, art and music therapy, and integrative medicine for developmental and behavioral conditions.

The expansion of scientific discoveries of biological factors that affect brain maturation and the interactions between the environment and the developing brain are addressed in a manner available to specialists and generalists. The scientific foundation and clinical application of new information about children with developmental and behavioral conditions include genetic disorders, neuromuscular disorders, seizures, diffuse brain injury, congenital infections, consequences of prematurity, inborn errors of metabolism, and nutritional disorders. Specific chapters address Down syndrome and fragile X syndrome. The impact of environmental chemicals on the developing brain is acknowledged with recognition of Dr. Herbert Needleman, a pediatrician and child psychiatrist. His research was responsible for the removal of lead from gasoline followed by reduction of children's blood lead level by 90% in the United States and an increase in average intelligence of American children by 5 IQ points.

An additional strength of DBP-5 is the use of an engaging clinical vignette at the beginning of each chapter. The story of a child or adolescent sets the stage for the work to establish a diagnosis and management plan. The narratives that follow connect the clinical presentation with available knowledge about each condition. A digital version is included with the book. DBP-5 is a testament to the growth in scientific discoveries and the maturation of clinical perspectives and skills applicable to the practice of developmental and behavioral pediatrics.