Updated evidence-based developmental attainments for children: First 6 years.

An accurate and well-rounded understanding of child development is essential to optimize child functioning and health. The First Six Years Developmental Attainments chart empowers clinicians to give parenting guidance and to evaluate age-specific developmental attainment of their pediatric patients. A practical knowledge translation tool, the chart integrates a comprehensive array of developmental skill attainments, citing the range of sources from classic to current literature. It includes definitions, explanations, and examples for skills, attainment age range, percentile, and oldest age of attainment where available so that the reader can 'estimate the age' for a child's skills in each developmental sector. Sub-headings focus the clinician's search for skills. This updated office reference is of critical use when clinicians guide parents with strategies suited to the child's level of developmental skills. With levels of evidence described, this clinical tool could be used for future national or international studies to develop strategies most useful for clinicians, trainees of different levels, and parents supporting child development.

Anticipatory guidance for behaviour concerns: School age children.

Parenting powerfully influences children's cognitive and social-emotional development. Parents often have behaviour concerns and seek advice from their clinician. This paper is an evidence-based clinic tool to empower clinicians to promote pro-social behaviour through developmentally-targeted strategies that parents can use to decrease problem behaviour. Typical scenarios are provided for noncompliance, aggression, attention, and bedtime worries. PARENTING PRINCIPLES: Authoritative parenting is essential for healthy outcomes. It combines warmth and structure to foster emotional regulation, attachment, and perspective-taking and problem-solving skills. A FRAMEWORK FOR DEVELOPMENTALLY-TARGETED PARENTING STRATEGIES: We present a framework for parenting strategies which integrates The Incredible Years Parenting Pyramid® and Antecedent-Behaviour-Consequence model, to guide parents on prevention of problem behaviour. The framework emphasizes daily relationship time and using empathy to the child to help him/her calm, become aware of his/her own emotions, and be receptive to the parent's instructions. It also teaches skills to replace the behaviour, providing physical needs, and explaining reasons for rules. When parents focus most of their time on the foundational skills of the pyramid, problem behaviour decreases, and consequences are rarely needed. MANAGING BEHAVIOUR CONCERNS: Managing behaviour concerns also requires screening for developmental and behavioural disorders, and following up to determine whether referrals are needed. CONCLUSION: Anticipatory guidance for behaviour concerns prioritizes children's rights to respect and dignity.

ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity.

Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 1, which focuses on diagnosis, include: prevalence, genetics, pathophysiology, differential diagnosis and comorbid psychiatric disorders and developmental disorders. In addition to database searches, the most recent guidelines of the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the National Institute for Health and Clinical Excellence, the Scottish Intercollegiate Guidelines Network, and the Eunethydis European ADHD Guidelines Group, were reviewed. Because ADHD is a heterogeneous disorder, comprehensive medical assessment for ADHD should always include a complete history, a physical examination, and a thorough consideration of differential diagnosis and related comorbidities. Specific recommendations for information gathering, testing, and referral are offered.

Anticipatory guidance for cognitive and social-emotional development: Birth to five years.

The present article serves as a quick office reference for clinicians, providing anticipatory guidance about the cognitive and social-emotional development of newborns, and children up to five years of age. The present review links recommendations to specific evidence in the medical literature, citing sources of developmental standards and advice, so that these may be further explored if desired. Practising primary care providers have indicated that these are areas of child development that are not well addressed by training and other available resources. The present article includes parenting information on important clinical presentations with which clinicians may be less familiar, such as promoting attachment, prosocial behaviours, healthy sleep habits, self-discipline and problem-solving; as well as on managing behaviours that are part of normal development, such as separation anxiety, tantrums, aggression, picky eating and specific fears. Information on the development of language, literacy and socialization are also included.

Le présent document se veut un aide-mémoire pour les cliniciens qui donnent des conseils préventifs sur le développement cognitif et socio-affectif des enfants de la naissance à cinq ans. Il lie les recommandations à des données probantes précises contenues dans les publications médicales et cite les sources des normes et des conseils en matière de développement afin de les consulter, au besoin. Il s'agit de domaines du développement des enfants qui, selon les dispensateurs de soins de première ligne en exercice, sont mal explorés pendant la formation et dans les ressources accessibles. Le présent article contient de l'information à l'intention des parents et des présentations cliniques importantes que les cliniciens connaissent peut-être moins bien, tels que la promotion de l'attachement, les comportements qui favorisent la socialisation, de saines habitudes de sommeil, l'autodiscipline, la résolution de problèmes et la gestion de comportements qui font partie d'un développement normal, comme l'angoisse de la séparation, les crises de colère, l'agressivité, les caprices alimentaires et des peurs précises. Le développement du langage, l'alphabétisation et la socialisation sont également abordés.

Evidence-based milestone ages as a framework for developmental surveillance.

Developmental surveillance is the process of monitoring child development over time to promote healthy development and to identify possible problems. Standardized developmental screeners have greater sensitivity than milestone-based history taking. Unfortunately, Canadian screening guidelines, to date, are sparse, logistical barriers to implementation have slowed uptake of screening tests and physicians continue to rely on milestones. When using clinical impression as a framework for surveillance, clinicians may not know when to consider a milestone delayed because developmental attainments exist within an age range and there is an absence of referenced percentiles on available published tables, which are particularly problematic for the cognitive and social-emotional sectors, which are less familiar to physicians. A novel, five-sector milestone framework with upper limits, referenced to the best available level of evidence, is presented. This framework may be used in teaching and may help physicians to better recognize failed milestones to facilitate early identification of children at risk for developmental disorders.

La surveillance du développement désigne le processus pour suivre l'évolution de l'enfant au fil du temps afin de promouvoir un développement sain et de repérer des problèmes possibles. Les outils standardisés de dépistage des troubles du développement sont plus sensibles que les antécédents fondés sur les étapes du développement. Malheureusement, jusqu'à présent, les lignes directrices canadiennes en matière de dépistage sont rares, et des obstacles logistiques à leur mise en œuvre en ont ralenti l'adoption. Par conséquent, les médecins continuent de se fier aux étapes du développement. Lorsqu'ils recourent à l'impression clinique comme cadre de surveillance, les cliniciens ne savent peut-être pas quand envisager le retard d'une étape du développement parce que leur atteinte se produit dans une plage d'âge et que les percentiles ne sont pas précisés dans les tableaux publiés, ce qui se révèle particulièrement problématique pour les secteurs cognitif et socioémotif, moins connus des médecins. Un nouveau cadre d'étapes du développement en cinq secteurs comportant des limites supérieures est présenté, d'après la meilleure qualité des preuves. Ce cadre peut être utilisé pour l'enseignement et peut aider les médecins à mieux reconnaître les étapes non atteintes pour faciliter le dépistage précoce des enfants vulnérables à des troubles du développement.