A template for you to assess and address behavior problems

Parents may receive conflicting views about child rearing from the media and family and friends. As a result, they often turn to you for advice. Simple counsel and encouragement may be adequate, but often you need more information before you can either reassure the parent that the child's behavior is normal or offer effective intervention.

To help primary-care physicians gather information and address behavior concerns, the Emotional Health Committee of the Maryland Chapter of the American Academy of Pediatrics developed a template, the Developmental Troubleshooter's Eclectic Checklist for Kids and Teenagers (D-TECKT), that provides a comprehensive approach to parental concerns about child and adolescent behavior problems. The checklist has three sections:

The D-TECKT was developed as an outgrowth of the Emotional Health Committee's interest in teaching residents and practitioners ways to effectively assist struggling parents. It was first presented in a workshop at the national meeting of the Society for Behavioral and Developmental Pediatrics in March 2002. It has also been presented to residents at several pediatric training programs and has been used by a sampling of pediatricians in private practice. We hope to expand its use and obtain systematic feedback from practitioners regarding its efficacy in stimulating and supporting the clinical thought process during diagnostic evaluation of pediatric behavior problems.

The D-TECKT provides a user-friendly method for organizing your thoughts when you're presented with child and adolescent behavior problems. Data may be collected in bits and pieces during telephone conversations, well-child visits, or more comprehensive behavioral visits. As you collect information, you can begin to develop a hypothesis about where, within the D-TECKT schema, the problem lies. You can then suggest interventions consistent with the working hypothesis. At times, an initial hypothesis and strategy may need to be revised and an alternate plan substituted. By reflecting on the dynamics behind the presenting behavior, you can select appropriate interventions and steer away from giving reflex suggestions for managing a given behavior.

Some behavior problems may arise from several areas of the D-TECKT schema. In such cases, you may need to implement interventions in order of perceived priority. You can implement strategies to the degree that you feel comfortable and refer patients to mental health consultants when the problem exceeds your comfort level. The "Searching for clues" checklist allows you to frame and record your impressions and hypotheses as you work with families. The cases provide some examples of the kinds of clues you might investigate for particular patients.