Behavioral Pediatrics: A Time for Research

¹ From the William T. Grant Foundation and Department of Pediatrics, Cornell University Medical College, New York

There are many children with problem behaviors who are not being helped, in large measure because we do not know enough about the causes of their problems or the effectiveness of therapy for them. The study of office visits by Starfield et al¹ demonstrated that at least 15% of children have psychosomatic problems and another 5% to 10% social and behavioral problems (Table 1). The cause and impact of these problems are like the interrelated layers of an onion, with biologic and social environmental forces interacting to ultimately affect the functioning of the child. These are not new problems. Although the term "the new morbidity" has been applied to many of them, most are not "new." In colonial times in America, one third of the women were pregnant at the time of their marriage. Premarital conception was an issue then as it is now. It is only the solution or consequences that are different today. The great frequency of these problems yesterday and today, the serious impact that they have, and the failure to treat or prevent most of these problems suggest that a major effort should be placed on research.

Advocating research does not mean that we should scrap current service programs as advocated by some² or isolate the research worker from the stress and difficulty of coping with clinical problems and real people. Romano³ said, "clinical medicine is not a spectator sport," and I would add that clinical research in behavioral pediatrics cannot be a spectator sport but is best done by those who are actively caring for children with problem behaviors.