In July 2011, the Australian federal government announced expansion of early intervention funding. Children diagnosed with cerebral palsy, Down syndrome, Fragile X syndrome and hearing and vision impairments are now eligible in addition to the existing funding for children diagnosed with autistic disorders. By deciding who gets the funding according to a set of accepted diagnoses, many children with equivalent if not greater levels of early intervention special need are excluded. In this viewpoint, we consider the fairness of this approach, and argue that while it may make sense from a political point of view, it is hard to justify, and possibly even discriminatory, from clinical, ethical and legal perspectives.

This paper considers diagnostic frameworks in developmental-behavioural paediatrics. The purpose of a diagnostic assessment is reviewed, and the use of categorical diagnoses is explored. A multi-level process of diagnostic formulation is outlined, highlighting the importance of a comprehensive focus on presenting symptoms, neuropsychological constructs, biological factors and environmental influences. The axis of time, developmental benchmarks and the enhancement of resilience are discussed as part of the diagnostic formulation framework. Limitations imposed on diagnostic practice by systemic and personal factors are reviewed. Implications for training and practice are discussed.

Contemporary paediatric practice includes considerable exposure to complex, chronic problems with prominent elements of social and emotional disruption. The psychological burden placed on paediatricians involved in this type of work is poorly recognised, both during training and beyond. Personal supervision for paediatricians is put forward as a potentially useful process to assist in maintenance of professional standards and personal well-being.

For our specialist paediatric workforce to be suitably equipped to deal with current childhood morbidity, a high level of competence in developmental-behavioural paediatrics (DBP) is necessary. New models of training and assessment are required to meet this challenge. An evolution of training in DBP, built around the centrepiece of competency-based medical education, is proposed. Summative assessment based upon entrustable professional activities, and a menu of formative workplace-based assessments specific to the DBP context are key components. A pilot project to develop and implement these changes is recommended.