1) You have recently written a book about pediatric growth and development. What led you to this book?

During my internship in pediatrics at Children's Hospital Boston, a sensational trial occurred in Boston regarding the death of Matthew Eappen, an infant thought to have been killed by his British nanny, Louise Woodward. There was a tremendous disconnect between the case as portrayed by the media and the nanny's lawyers, and the reality known to any pediatrician versed in child abuse. So I took my elective time and decided to write a detailed investigative account of the case, from a physician's perspective. This essay became one of the chapters in my book, A Map of the Child, which is an exploration of the medical, social, and political determinants of children's health, told in a narrative manner. (An archive of my work appears at my website, http://www.darshaksanghavi.com .)

2) Why is it important for parents and teachers to know about and study child development?

Raising children is a complicated journey, and unfortunately there is no standard societal mechanism for educating people about how to nurture and help children grow. Most individuals rely mostly on occasional visits to a pediatrician, knowledge passed down from elders, and occasionally parenting books. But there is a great deal of data about children's development, and this knowledge can help us all be better mentors for children.

3) Over the past 50 years, there seems to have been an increase in psychiatric medication. Are we overmedicating our children and adolescents? Ritalin has been around for years, and now we have Concerta, Strattera, Adderol, and Cylert. Is there any difference between these drugs and are they being used appropriately? Are we too eager to diagnose children?

It seems that we are continually seeing an increase, particularly in psychiatric diagnoses. Due to increased awareness and diagnosis, drug treatment for ADHD has been skyrocketing. For example, Maryland, which tracks ADHD cases, saw a six-fold increase in diagnoses since the 1970s. But despite the popular impression that these drugs are over-prescribed, no studies in respected medical journals confirm that fear. Today, less than two-thirds of doctors use the right questionnaires to diagnose ADHD, perhaps causing misdiagnosis. Some don't check for other problems like depression, which may be an additional or alternative explanation for school problems. Still, drugs work very, very well for children who do meet the criteria for ADHD-which may be 5 to 10 percent of children. By 1997, it became clear that affected children responded spectacularly to drug treatment. Researchers at McMaster University in Canada systematically compiled 92 studies and showed that more than 70 percent of patients taking methylphenidate (Ritalin) and dextroamphetamine (Adderall) responded to the drugs.

Despite the availability of many medications, I am not aware of major studies that distinguish whether any specific stimulant medications is better than another. Though behavioral therapy and greater adult involvement have great appeal for treating ADHD, they're less effective than drugs. In a major 1999 National Institute of Mental Health-sponsored project, children getting 35 behavioral therapy sessions, an in-class teaching aide, a summer treatment program, and specialized teacher and parent counseling didn't do much better than another group of children who didn't get such intensive therapy. But a third group on medication did much better, and adding behavioral interventions for children taking the drugs provided some modest benefit. It's critical to make the diagnosis correctly, and to follow children very closely. But in the end, we should stop blaming parents, teachers, and pediatricians for diagnosing ADHD. As Malcolm Gladwell writes in The New Yorker, the world mourned by critics of drug treatment for ADHD was ''a ruthlessly Darwinian place" where kids with ''neurological quirks" were simply allowed to fail. Today, many people are no longer content to see these children left behind and they shouldn't feel guilty for using medicine to help them.

5) Your book "A Map of the Child" has been well received. You have spoken about it on NPR and in several cities across he U.S. What makes it memorable and why is it important? What are the main " markers" if you will in terms of your " map of the child"?

Childhood is an extraordinary period, from biological, chemical, social, and political standpoints. The book is structured as a "tour" of a child's developing body, with narratives about children coping with illness as the framework of each chapter. The chapters have provocative titles-"Blood", "Lungs", "Bones", and so on. But what is particularly poignant is that each chapter also has a more abstract theme-the search for freedom, the need for redemption, the nature of love, and so on. These children have moving, extraordinary experiences, and I try to place their struggles in a broader context.

My friend who had a bone marrow transplant, the premature baby whose lungs weren't fully developed, the newborn who wasn't quite a boy or girl at birth, the teenage boy who had a positive pregnancy test-many such stories are told in the book in a manner that is hopeful and contemplative, but still based in medical fact and with many lessons for parents and teachers of healthy children.

7) What "top ten" things should parents know about their child's development?

There's no right answer here, but I can give you some admittedly personal answers, based on my experience as the father of two sons and my clinical work. In no particular order, I think the following are the most important features to pay attention to in a child's

development: Nurturing moral awareness, good organizational skills, a healthy level of self-confidence and assertiveness, interest in physical activity and good nutrition, love of reading, critical thinking, guidance for development of healthy sexual behavior, tolerance for others, a sense of humor, and conflict resolution.

9) What should parents be alert to in terms of developmental delays?

Development is a variable process, since different children develop at different times. However, many significant developmental delays are present from early childhood. Thus, it's sometimes difficult to distinguish "late bloomers" from those who may have more significant delays. I recommend speaking in detail with your doctor during check-ups to understand what technique they use to assess development. Parents should have some basic understanding about what children should be able to do at their particular age. Pediatricians use many different scoring systems to assess development at check-ups, and these each have certain strengths and weaknesses.

For example, I've always used the "Denver" scoring system, which assesses language, gross motor, fine motor, and social skills. However, it's not very good at picking up delays in language. Thus, I'm extra careful with children who have hearing or speech issues, and not entirely reliant on the Denver score for them. In particular, I recommend a more thorough evaluation any time an adult is very concerned or suspicious about development delay in their child, usually by referring to the state's Early Intervention program. It's surprising how often parents or teachers turn out to be right.

These evaluations are typically and hour or two in duration, and often performed by developmental pediatricians or occupational/physical therapists.

10) What is the single most important question facing researchers in terms of child development?

A great deal of research attempts to tease apart the influence of "nature" versus "nurture" in child development. The underlying assumption is that "nature" implies a fixed characteristic that can't be changed, and "nurture" uncovers things that can be modified. These kinds of studies try to identify things that social policy or teachers or parents can alter to help kids-but also characteristics that basically "can't be helped." Unfortunately, development is such a messy process that these studies inevitably confuse parents and educators because no certain conclusion can be drawn. These studies have created a sort of "tyranny of data" in which poorly designed studies are used to justify or refute important social and educational policies. In the end, I think the biggest challenge facing researchers is dealing with (or more clearly acknowledging) the tremendous limitations of clinical research methods in understanding child development on a fundamental level.

Darshak Sanghavi is a clinical fellow at Harvard Medical School and Children's Hospital, Boston. Currently, he is clinically active as a pediatric cardiologist, and recently worked for several years as a pediatrician for the U.S. Indian Health Service in Navajo country. He has published scientific papers on topics ranging from the molecular biology of cell death to tuberculosis transmission patterns in Peruvian slums. A medical columnist for the Boston Globe and commentator for NPR's All Things Considered , Sanghavi also serves on the advisory board of Parents magazine and is a visiting media fellow of the Kaiser Family Foundation . His recent book, A Map of the Child: A Pediatrician's Tour of the Body (Henry Holt), deals narratively with the social, political, and medical determinants of pediatric health today. Dr. Sanghavi's website is http://www.darshaksanghavi.com