Unmet developmental, behavioral, and psychosocial needs in children attending pediatric outpatient clinics

OBJECTIVE: In this study of children attending general pediatric hospital outpatient clinics, we aimed to examine the proportion of (1) children with developmental and behavioral concerns; (2) parents with mental health problems; and (3) families with less than adequate psychosocial resources. We were also interested in the extent to which pediatricians discussed these problems with parents. METHODS: This was a cross-sectional study of families with children aged 4 to 8 years attending pediatric outpatient clinics at the Royal Children's Hospital, Melbourne. The Strengths and Difficulties Questionnaire, Parents' Evaluation of Developmental Status, Kessler-6 Scale for Psychological Distress, and Family Resource Scale were administered postvisit to assess development and behavior, parental mental health, and psychosocial resources. Parents were asked whether these issues were discussed during the consultation. RESULTS: A total of 162 families participated. Behavioral concerns were identified in 26% of children and concerns about language and motor development in 24% and 11%, respectively. Only 39% of consultations included discussion about development and 46% about behavior. Almost two-thirds (64%) of families reported less than adequate psychosocial resources, yet fewer than 10% of consultations included discussion of this, and only 7% addressed parental mental health. Parental perception of reasons why concerns were not discussed included "not relevant" (47%) and "the doctor did not bring it up" (21%). Only 2% of parents "didn't want to discuss the concern." CONCLUSIONS: A high proportion of children and families attending pediatric outpatients have unidentified concerns in development and/or behavior, and parents have mental health or psychosocial issues; these concerns are often not discussed, and thus opportunities for timely intervention are missed.