4. Middle childhood
Distinguish between fears and phobias 2008;29:207
Develop a plan for managing fears 2008;29:207
Know when lying and stealing indicate severe psychiatric
disturbance
2008:185
Know the importance of guidance during middle childhood
regarding discipline
2009;30:366
5. Adolescence
Recognize that some aggressive negative behavior may be
adolescent rebellion: contrast frequency, severity, duration of
symptoms
2011;32:325
2007;28:433
Identify the behavioral changes common with the onset of
early adolescence: fatigue, increased sleeping, irritability,
secretiveness, easy embarrassment
2011;32:223
2010;31:189
B. Externalizing behaviors and conditions
1. Aggressive behaviors (eg, aggression, ODD, CD,
antisocial behaviors)
Differentiate aggressive behavior from normal variants (eg,
aggressive oppositional variant)
2011;32:325
Recognize the environmental and biological contributors to the
development and maintenance of aggressive behaviors
2011;32:325
Understand the factors related to biting at various stages of
development
2011;32:325
Understand the influences of exposure to violence in the
media on aggressive behavior in children and adolescents
2011;32:325
Understand the association between child maltreatment and
later aggressive behavior
2011;32:325
Understand the association between corporal punishment and
aggression in children, adolescents, and adults
2011;32:325
Plan the evaluation of a child with aggressive behavior (eg,
school-family information, developmental milestones, child
interview, rating scales for ADHD, ODD/CD)
2011;32:325
Understand the role of rating scales and questionnaires in the
assessment of a child with aggressive behavior
2011;32:325
Understand the management of aggressive behavior at
different ages
2011;32:325
Know how to advise families on the management of
aggressive, biting, or bullying behavior
2011;32:325
2010;31:e68
Know how to advise a school or child-care center on the
management of aggressive, biting, or bullying behavior
2011;32:325
2010;31:e68
2. Disruptive behaviors (eg, oppositionality, ODD, CD)
Understand that starting fires and cruelty to animals may
indicate an underlying psychiatric disturbance
2011;32:325 2008:185
Understand the stages of development typically associated
with oppositional behaviors (eg, tantrum in toddler,
adolescence)
2011;32:325
2010;31:209
Recognize the natural history of oppositional defiant or
conduct disorder based on the developmental stage
2011;32:325
Recognize the behavioral and functional characteristics of
oppositional defiant or conduct disorder and the variations in
presentation
2011;32:325
Distinguish between oppositional defiant or conduct disorder
and temperamental variations
2011;32:325
Understand the range of prognoses for children with
oppositional defiant or conduct disorder
2011;32:325
Recognize the environmental (eg, family systems, community)
and biological (eg, genetics, co-existing conditions)
contributors to oppositional and defiant behaviors
2011;32:325
Recognize the common conditions occurring in concert with
oppositional defiant or conduct disorder (eg, ADHD, learning
difficulties)
2011;32:325
Understand how to evaluate a child with defiant, oppositional,
or delinquent behavior (eg, school-family information,
developmental milestones, child/adolescent interview, rating
scales)
2011;32:325
Know the criteria for referral of a child with defiant,
oppositional, or delinquent behavior
2011;32:325
Understand the role of rating scales and questionnaires in the
assessment of disruptive behaviors (eg, Vanderbilt, Conners)
2011;32:325 2012:116
Know the role of behavioral modification strategies in the
management of disruptive behaviors
2011;32:325
3. Antisocial behaviors, delinquency
Know the associated signs of antisocial behavior: poor school
performance, truancy, poor self-esteem, low frustration
tolerance
2011;32:325
2007;28:433
Know that antisocial behavior may be indicative of other
disorders: depression, anxiety, psychosis
2011;32:325
2007;28:433
Recognize the environmental and biological contributions to
the development and maintenance of antisocial behaviors
2011;32:325
Know how to evaluate a child with antisocial behavior 2011;32:325
Know the criteria for referral of a child with antisocial behavior 2011;32:325
Understand the role of rating scales and questionnaires in the
assessment of antisocial behaviors
2011;32:325
Be aware of the therapeutic options available for managing
antisocial behavior in an adolescent
2011;32:325
2008;29:250
2007;28:433
C. Internalizing behaviors and conditions
1. Anxiety
Recognize the signs and symptoms of phobias and anxiety
disorders and the range of common presentations
2008;29:250
2. Mood and affect disorders
Understand that depressive disorders may present a variety of
symptoms (eg, fatigue, somatic complaints, school problems,
acting out, irritability)
2009;30:199
Understand the depressive mood swings of a normal
adolescent
2009;30:199
Recognize the biologic correlates (eg, sleep issues, change in
appetite) of depression
2009;30:199
Understand the epidemiology of depression in children and
adolescents (eg, gender-based differences, age-based
differences)
2009;30:199
Recognize that acting out and oppositional behaviors rather
than vegetative symptoms can be seen in youth with
depression
2009;30:199
Understand that depression and substance abuse are more
common in teens with sexual orientation issues (eg, gay,
bisexual)
2011;32:91
2009;30:199
2011:200
Understand the association of depression with complex illness 2009;30:199
Understand the association between depression and
substance use/abuse
2009;30:199
Recognize anxiety as a concomitant to depression 2009;30:199
Understand the association between anger/hostility and
anxiety and depression in adolescents
2009;30:199
Recognize the environmental and biological (eg, genetic)
contributors to the development of depressive disorders
2009;30:199
Recognize the common co-existing conditions of depressive
disorders
2009;30:199
Distinguish between a major depressive disorder, dysthymia,
and brief grief reactions, and adjustment disorder with
depressed mood
2009;30:199
Understand the role of rating scales and questionnaires for the
assessment of depressive behaviors (eg, PHQ-9, Columbia
Teen Screen, Beck Depression Inventory)
2009;30:199
Understand the pharmacologic and non-pharmacologic
treatment approaches to depression
2009;30:199
D. Suicidal behavior
Understand that self-poisoning after 6 years of age is not likely
to be accidental
2009;30:199
Understand that asking a child or adolescent about suicidal
thoughts or actions will not "put such ideas into his/her head"
2009;30:199 2010:104
Understand the warnings signs of suicide (eg, isolation from
friends, giving things away)
2009;30:199
Understand that self-inflicted harm, even in children, may be a
sign of an attempted suicide
2009;30:199
Know that publicity regarding suicide may prompt other
adolescents to attempt suicide
2009;30:199
Know the epidemiology of suicide attempts 2009;30:199
Know the epidemiology of mortality due to suicide 2009;30:199
Recognize that the psychologic intent does not always
correlate with the seriousness of the physical suicide attempt
(suicidal gestures must be taken seriously)
2009;30:199
Identify the features of a child's or adolescent's suicide attempt
that indicate a more or less serious situation
2009;30:199
Understand that homosexual adolescents are at risk for
suicide
2009;30:199
Know the risk factors associated with suicidal behavior in
children and adolescents
2009;30:199
Know the risk factors associated with a poor prognosis for
children and adolescents who have attempted suicide
2009;30:199
Know how to assess a child or adolescent with suicidal
ideation
2009;30:199
Know the indications for hospitalization of a child or adolescent
at risk of suicide
2009;30:199
E. Psychotic behavior, thought disorders
Understand the behaviors suggestive of schizophrenia 2008:215
F. Disorders of attention and impulse control
1. Clinical features, presentation
Recognize that the prevalence rate of ADHD is higher in boys
than in girls
2010;31:56
Know the spectrum of symptoms that can occur with ADHD
subtypes (inattention, impulsivity, hyperactivity)
2010;31:56
Recognize that anxiety or depression can present as
hyperactivity or inattention
2010;31:56
Know that ADHD is difficult to accurately diagnose in the early
years of life
2010;31:56
Know that ADHD-combined type reaches its peak prevalence
of identification in the early elementary school years, but that
ADHD-inattentive subtype may not be identified until later in
the school career
2010;31:56
Know the long-term outcome for children with ADHD as
adolescents and adults
2010;31:56 2012:222
Know the differential diagnosis of a child presenting with
behavior problems in school
2010;31:56
Understand that the manifestations of hyperactivity and
impulsivity decrease but that challenges with inattention
remain problematic over time
2010;31:56
Recognize that a large percentage of youth with ADHD will
have clinically significant impairment in adulthood
2010;31:56
Recognize that the most common presentation of ADHD in
preschool children is problems with hyperactivity and impulse
control
2010;31:56
2. Etiologies
Know that coexisting conditions (eg, oppositional defiant
disorder, conduct disorder, anxiety, depression, learning
disabilities) are frequently seen in children with ADHD
2010;31:56
Know the medical causes of hyperactivity and/or attention
difficulties
2010;31:56
Know the neurochemical basis of ADHD 2010;31:56
3. Screening and diagnostic evaluation 2010;31:56
Recognize that the diagnosis of ADHD cannot be made by use
of a specific test
2010;31:56
Recognize that observation of behavior in a physician's office
does not usually reflect the situation at school
2010;31:56
Understand the role of diagnostic studies in the evaluation of
disorders of attention, including laboratory, neuroimaging,
psychoeducational testing, and continuous performance tests
2010;31:56
Understand the reasons for requesting information on
symptoms
2010;31:56
Understand that patients with CNS-based chronic conditions
(eg, epilepsy, myelomeningocele, lead poisoning) are at
increased risk of ADHD
2010;31:56
4. Therapeutic options
Know that stimulant medications improve attention in normal
individuals as well as in children with attention deficit
hyperactivity disorder
2010;31:56
Know that medication alone is usually not sufficient for the
treatment of ADHD
2010;31:56
Recognize the importance of communicating with the teachers
of a child with ADHD when medications are used
2010;31:56
Know the medications used in treating ADHD 2010;31:56 2012:238
Know the side effects of medications used to treat ADHD, the
contraindications to their use, and the potential for their abuse
2010;31:56 2012:238
Know the management strategies for a child with ADHD and its
coexisting conditions (eg, behavioral management strategies,
special education placement, tutoring, cognitive monitoring
strategies, psychotherapy, hypnosis)
2010;31:56
Know the medical indications for the use of stimulant
medications outside of school hours
2010;31:56
Know that ADHD medications may be useful through
adolescence and beyond
2010;31:56
Know the beneficial effects of ADHD medications 2010;31:56
Understand that classroom accommodations for children with
ADHD may be implemented under Section 504 of the
Rehabilitation Act (504 Plan) or under the Individuals with
Education Disabilities (IED) Act
2010;31:56
XXIX. Psychosocial issues and problems
A. Family and environmental issues
1. General issues
Know the value of anticipatory guidance and the provision of
information and support for critical life events
2009;30:350
Identify regressive behavior and somatic complaints as signs
of stress
2009;30:350
Understand how to help families transition their adolescents
from a pediatric practice to a provider who cares for adults
2010;31:49
2. Critical life events
Understand that the developmental stage of a child will have
an impact on his/her response to a death in the family
2009;30:350
Recognize that a child's emotional adjustment to divorce may
affect his/her own subsequent intimate relationships
2011;32:257
Know how to counsel a family and child regarding the death of
a loved one
2009;30:350
Know the stages of grief and the spectrum of reactions for a
child and a family when a loved one dies: shock, anger, denial,
disbelief, sadness
2009;30:350
Recognize the patterns of responses of family members
(spouse, siblings) to a life-threatening or terminal illness
2009;30:350
Recognize the psychosocial issues surrounding the use of
home monitors
2007;28:203
Recognize the importance of physician review of case with
parents after SIDS has occurred (including risk of SIDS in
siblings)
2007;28:203
3. Impact of mass media
Understand the potential negative effects of TV viewing on
children: increases aggressive behavior; acceptance of
violence; obscures distinction between fantasy and reality;
trivializes sex and sexuality; increases passivity, obesity, &
perhaps the risk of suicidal behavior
2011:68
Know the average time children spend with television relative
to other activities (school, play, etc)
2011:68
Know about limit-setting techniques for TV time, including the
recommendation that children younger that 2 years of age
should not watch TV
2011:68
Know the relationship of TV viewing to the selection of toys,
cereals, and so forth
2011:68
4. Socioeconomic factors
5. Adoption
Understand the physician's role in international adoption 2008;29:292
6. Foster care
7. Discipline
Know the various forms of effective discipline (eg, time o