Fort Worth mom Lindsey Garner first noticed signs of autism in her sons (now 10 and 8) when they were toddlers. “With my oldest, I expressed concerns to our pediatrician when he was 2, but I got the typical ‘kids develop at different rates’ response,” she recalls. Garner knew in her gut that wasn’t the case here, but it still took years to get the formal diagnosis. When she saw behavior characteristic of autism in her younger son, Garner found a developmental-behavioral pediatrician (DBP) who evaluated him within weeks—and he quickly began receiving supportive services.
It was only because of what she’d gone through with her older son that Garner knew exactly what to do and who to consult. If you’re concerned about your child’s development, behavior or the impact of a disability or disorder, seeing a DBP can speed the process of getting answers and a treatment plan.
What’s a Developmental-Behavioral Pediatrician?
DBPs evaluate, treat and recommend therapies for children who have (or are at risk for) developmental and behavioral concerns. While some practices specialize in particular areas, the wide range of conditions experienced by children who see DBPs include:
- Learning disorders, such as dyslexia, writing difficulties and math disorders
- Attention and behavioral disorders, such as ADHD and oppositional-defiant behavior
- Depression and anxiety
- Tics and Tourette syndrome
- Developmental disabilities, including cerebral palsy, spina bifida, intellectual disability, autism spectrum disorders, and visual and hearing impairments
- Regulatory disorders, such as sleep disorders, feeding problems, bedwetting and soiling
- Delayed speech, language, motor skills and cognitive ability
- Other conditions that come with higher risk for developmental problems, such as genetic disorders, epilepsy, prematurity, congenital heart disease and cancer
A DBP’s expertise comes from a three-year fellowship that follows the three-year residency in general pediatrics. Part of their training includes understanding school systems and how to advocate for special education services. “We can provide a full evaluation and assist the family and child with a comprehensive treatment plan, in order to set them up for developmental and educational success,” explains Dr. Sari Bar, assistant professor in the Division of Developmental-Behavioral Pediatrics at UT Southwestern Medical Center and medical director for the Developmental Behavioral Pediatrics Clinic at Children’s Health in Dallas.
Some conditions treated by DBPs have relatively clear symptoms; Garner noticed her younger son flapping his hands, not making eye contact, and babbling and making sounds rather than speaking. In other cases, a child’s condition may be more subtle. The Cook Children’s Child Study Center in Fort Worth suggests speaking to your pediatrician about whether a referral to a DBP is needed when your child falls behind peers in developmental milestones; they lose skills they previously had; or there is a family history (especially with the child’s siblings) of developmental or behavioral conditions.
DPBs can provide various interventions, from assessment and diagnosis to referrals to therapy providers, recommended behavior strategies for home and even medication when needed. While your general pediatrician should be your first contact about developmental, behavioral or learning issues, Bar advises parents to not delay seeking out a DBP if the issue isn’t solved.
Appointments, Developmental Assessments and Treatment Processes
In some cases, you can self-refer to a DBP practice, while other clinics and forms of insurance require a referral from your regular pediatrician. When you do get an appointment, keep in mind that the date could be a long way out. According to Cook Children’s Child Study Center team, there is a national shortage of these doctors—while there are several thousand general pediatricians in Texas alone, there are only about 700 DBPs in the United States.
Depending on your child’s symptoms or condition, Bar recommends that parents move forward with evaluations by occupational, physical and speech therapists and an audiologist. If you’re not committed to a particular DBP, you can check wait times for other practices—that’s what Garner did for her younger son’s appointment after a long delay the first time around.
Even once your child is an established DBP patient, general pediatricians will continue to be an important part of the overall care team. “Our regular pediatrician has been great for addressing typical childhood health issues—immunizations, routine checkups, ear infections,” Garner shares. In some cases, the general pediatrician is tasked with managing the developmental or behavioral concern after the child has been evaluated by the DBP, often because of high demand for the specialist’s care.
Ultimately, the exact role a DBP will play in your child’s life varies based on personal needs. Garner notes that her family’s relationship with developmental pediatricians was limited to assessments, diagnosis and therapy recommendations, as well as insurance-required follow-ups. However, “many DBPs continue to see patients on a regular basis to discuss school challenges and make recommendations about school services and interventions,” Bar says. “If a patient is receiving medication treatment, they would follow up with the DBP more regularly.”
As your child grows up, your family will have to begin looking at other options. “There is no adult-equivalent specialty of DBP,” Bar explains. “It can be challenging to find a GP [general practitioner] who specializes in this population or in specific disorders.” Still, a family practice doctor or internal medicine physician may be able to prescribe your adult child’s medication; another option is seeing an adult psychiatrist. If your child’s disorder or disability impacts motor function, they can continue seeing specialists in physical medicine and rehabilitation.
DBPs Can Guide Families to a New Normal
Assessments, therapy, medications—it can seem overwhelming. But a DBP can provide key guidance to get your family on the road to a new normal as fast as possible. “When we were first beginning our autism journey, the developmental pediatrician helped us get started providing our children the supports they needed,” Garner notes. “Without their expertise, we wouldn’t have known where to begin.”
Developmental-Behavioral Pediatricians in Dallas-Fort Worth
Developmental-behavioral pediatricians aren’t plentiful, but here are a few options to consider near you:
Children’s Health Developmental Behavioral Pediatrics (DBP) Clinic. Dallas, 214/456-5558; childrens.com
Cook Children’s Child Study Center. Fort Worth, 682/303-9200; cookchildrens.org/services/child-study-center
Jacob’s Ladder Developmental Pediatrics. Frisco, 469/476-1444; jacobsladderdevpeds.com