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American Academy of Pediatrics
Developmental and
Behavioral Pediatrics
2ND EDITION
Section on Developmental and Behavioral Pediatrics

EDITOR
Robert G. Voigt, MD, FAAP

ASSOCIATE EDITORS
Michelle M. Macias, MD, FAAP
Scott M. Myers, MD, FAAP
Carl D. Tapia, MD, MPH, FAAP
American Academy of Pediatrics Publishing Staff
Mark Grimes, Vice President, Publishing
Eileen Glasstetter, MS, Senior Editor, Professional/Clinical Publishing
Theresa Wiener, Production Manager, Clinical and Professional Publications
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adolescents, and young adults.
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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form
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fax the permissions editor at 847/434-8000 or e-mail permissions@aap.org). First edition published 2011.
Printed in the United States of America
3-339/0418 1 2 3 4 5 6 7 8 9 10
MA0844
ISBN: 978-1-61002-134-0
eBook: 978-1-61002-135-7
EPUB: 978-1-61002-239-2
Mobi: 978-1-61002-240-8
Library of Congress Control Number: 2017935587
Section on Developmental and Behavioral Pediatrics
2017–2018
5
Executive Committee Members
Carol C. Weitzman, MD, FAAP, Chairperson
Nerissa S. Bauer, MD, MPH, FAAP
David O. Childers Jr, MD, FAAP
Jack M. Levine, MD, FAAP
Ada Myriam Peralta-Carcelen, MD, MPH, FAAP
Peter J. Smith, MD, MA, FAAP
Immediate Past Chairperson

Nathan J. Blum, MD, FAAP
Liaisons
Marilyn Augustyn, MD, FAAP
Rebecca A. Baum, MD, FAAP
Beth Ellen Davis, MD, MPH, FAAP
Alice Meng, MD, FAAP
Program Chairperson
Carolyn Bridgemohan, MD, FAAP
Newsletter Editor
Web Site Editor

Kimberlly L. Stringer, MD, FAAP
Staff
Linda B. Paul, MPH
Editors and Contributors
5
Editor in Chief
Professor of Pediatrics
Head, Section of Developmental Pediatrics
Baylor College of Medicine
Director, Meyer Center for Developmental Pediatrics and Autism Center
Texas Children’s Hospital
Houston, TX
Associate Editors
Chief, Division of Developmental-Behavioral Pediatrics
Medical University of South Carolina
Charleston, SC

Neurodevelopmental Pediatrician
Associate Professor of Pediatrics
Geisinger Autism & Developmental Medicine Institute
Lewisburg, PA

Assistant Professor, Department of Pediatrics
Houston, TX
vi
Contributors
Kruti R. Acharya, MD, FAAP
Assistant Professor of Disability and Human Development
University of Illinois at Chicago
Chicago, IL
Ch 26: Transition to Adult Medical Care
William J. Barbaresi, MD, FAAP

Director, Developmental Medicine Center
Wade Family Foundation Chair in Developmental Medicine
Boston Children’s Hospital
Harvard Medical School
Boston, MA
Ch 17: Learning Disabilities
Ch 21: Disruptive Behavior Disorders

Chief, Division of Developmental and Behavioral Pediatrics
The Children’s Hospital of Philadelphia
William H. Bennett Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, PA
Ch 7: Basics of Child Behavior and Primary Care Management
of Common Behavioral Problems
Thomas D. Challman, MD, FAAP

Medical Director
Lewisburg, PA
Ch 19: Autism Spectrum Disorder
Ch 24: Complementary Health Approaches in Developmental and Behavioral Pediatrics
Eugenia Chan, MD, MPH, FAAP

Assistant Professor of Pediatrics
Division of Developmental Medicine
Boston, MA
Ch 23: Basics of Psychopharmacological Management
vii
Viola Cheung, DO, FAAP

Developmental Behavioral Pediatrician
TJH Medical Services
Medisys Child Development and Education Center
Flushing Hospital Medical Center
Flushing, NY
Ch 22: Anxiety and Mood Disorders

Chief, Division of Developmental Pediatrics
Chief, Division of General Academic Pediatrics
Chief, Division of Child Neurology
Director Regional Early Intervention Program
University of Florida College of Medicine–Jacksonville
Jacksonville, FL
Ch 6: Early Intervention
Peter J. Chung, MD, FAAP

Assistant Clinical Professor of Pediatrics
Division of Developmental-Behavioral Pediatrics
Center for Autism & Neurodevelopmental Disorders
University of California, Irvine
Santa Ana, CA
Stephen H. Contompasis, MD, FAAP

Emeritus Professor of Pediatrics
Larner College of Medicine
University of Vermont
Burlington, VT
Benard P. Dreyer, MD, FAAP

Director of Developmental-Behavioral Pediatrics
NYU School of Medicine and Hassenfeld Children’s Hospital at NYU Langone
Director of Pediatrics
Bellevue Hospital Center
New York, NY
Ch 3: Environmental Influences on Child Development and Behavior
viii
John C. Duby, MD, FAAP, CPE

Professor and Chair, Department of Pediatrics
Wright State University Boonshoft School of Medicine
Vice President of Academic Affairs and Community Health
Dayton Children’s Hospital
Dayton, OH
Ch 12: Social and Emotional Development
Ellen R. Elias, MD, FAAP, FACMG

Professor of Pediatrics and Genetics
University of Colorado School of Medicine
Aurora, CO
Ch 4: Biological Influences on Child Development and Behavior and Medical Evaluation
of Children With Developmental-Behavioral Disorders
Jason M. Fogler, MA, PhD

Staff Psychologist
Codirector of ADHD Services
The Division of Developmental Medicine
Instructor in Psychiatry
Boston, MA
Ch 17: Learning Disabilities
Jill J. Fussell, MD, FAAP

Professor
Developmental Behavioral Pediatrics Fellowship Director
Medical Director of the James L. Dennis Developmental Center
Section of Developmental Pediatrics and Rehabilitative Medicine
University of Arkansas for Medical Sciences
Arkansas Children’s Hospital
Little Rock, AR
Ch 15: Cognitive Development and Disorders
Dinah L. Godwin, MSW, LCSW

Meyer Center for Developmental Pediatrics
Houston, TX
Ch 25: Social and Community Services for Children With Developmental Disabilities
and/or Behavioral Disorders and Their Families
ix
Elizabeth B. Harstad, MD, MPH

Boston, MA
Ch 21: Disruptive Behavior Disorders
Pamela C. High, MD, FAAP

Director, Developmental-Behavioral Pediatrics
Hasbro Children’s Hospital
Warren Alpert Medical School, Brown University
Providence, RI
Carrie Kelly, MD, FAAP

Providence, RI
Desmond P. Kelly, MD, FAAP

University of South Carolina School of Medicine Greenville
Vice Chair for Academic Affairs, Department of Pediatrics
Greenville Health System Children’s Hospital
Greenville, SC
Ch 13: Sensory Impairments: Hearing and Vision
Mary C. Kral, PhD

Charleston, SC
Ch 20: Interpreting Psychoeducational Testing Reports, Individualized Family Service
Plans (IFSP), and Individualized Education Program (IEP) Plans
Angela C. LaRosa, MD, MSCR, FAAP

Charleston, SC
Ch 16: Speech and Language Development and Disorders
x
Austin A. Larson, MD
Instructor, Department of Pediatrics
Section on Genetics
Aurora, CO
Ch 4: Biological Influences on Child Development and Behavior and Medical Evaluation
of Children With Developmental-Behavioral Disorders
Michele L. Ledesma, MD, FAAP

Fellow, Developmental & Behavioral Pediatrics
Department of Pediatrics
Yale School of Medicine
New Haven, CT
Mary L. O’Connor Leppert, MB, BCh, FAAP

Director, Center for Development and Learning
Kennedy Krieger Institute
Johns Hopkins University School of Medicine
Baltimore, MD
Ch 10: Developmental Evaluation
Paul H. Lipkin, MD, FAAP

Kennedy Krieger Institute
Johns Hopkins University School of Medicine
Baltimore, MD
Ch 9: Developmental and Behavioral Surveillance and Screening
Within the Medical Home

Chief, Division of Developmental-Behavioral Pediatrics
Charleston, SC
Ch 1: Child Development: The Basic Science of Pediatrics
Ch 9: Developmental and Behavioral Surveillance and Screening
Within the Medical Home
xi
Shruti Mittal, MD, FAAP

Charleston, SC
Catherine Morgan, PhD

Senior Research Fellow
Cerebral Palsy Alliance Research Institute, School of Medicine
University of Sydney
Sydney, NSW
Australia
Ch 14: Motor Development and Disorders
Michael E. Msall, MD, FAAP

Professor of Pediatrics, University of Chicago
Co-director Kennedy Research Center on Intellectual and
Neurodevelopmental Disabilities
Chief of Developmental and Behavioral Pediatrics
Comer Children’s Hospital
Chicago, Illinois
Ch 14: Motor Development and Disorders

Neurodevelopmental Pediatrician
Lewisburg, PA
Ch 19: Autism Spectrum Disorder
Ch 24: Complementary Health Approaches in Developmental and Behavioral Pediatrics
Mary E. Pipan, MD, FAAP

Clinical Director, Trisomy 21 Program
Attending Physician, Developmental Behavioral Pediatrics
The Children’s Hospital of Philadelphia
Philadelphia, PA
Ch 7: Basics of Child Behavior and Primary Care Management
of Common Behavioral Problems
xii
Jennifer K. Poon, MD, FAAP

Charleston, SC
Ch 6: Early Intervention
Michael I. Reiff, MD, FAAP

Professor, Department of Pediatrics
Division of Pediatric Clinical Neuroscience
University of Minnesota
Minneapolis, MN
Ch 18: Attention-Deficit/Hyperactivity Disorder
Marie Reilly, MD
Instructor in Pediatrics
Boston, MA
Ch 8: Development and Disorders of Feeding, Sleep, and Elimination
Ann M. Reynolds, MD, FAAP

Section of Developmental Pediatrics
Children’s Hospital Colorado
Aurora, CO
Ch 15: Cognitive Development and Disorders
Julie Ribaudo, LMSW, IMH-E(IV)

Clinical Associate Professor
University of Michigan School of Social Work
Ann Arbor, MI
Ch 5: Interviewing and Counseling Children and Families
Angelica Robles, MD, FAAP

Providence, RI
xiii
Alison Schonwald, MD, FAAP

Assistant Professor of Pediatrics, Harvard Medical School
Assistant in Medicine, Boston Children’s Hospital
Boston, MA
Ch 8: Development and Disorders of Feeding, Sleep, and Elimination
Prachi E. Shah, MD, MS

Associate Professor, Pediatrics
Division of Developmental and Behavioral Pediatrics and
Center for Human Growth and Development
University of Michigan
Ann Arbor, MI
Ch 5: Interviewing and Counseling Children and Families

Associate Professor, Pediatrics
Section of Developmental-Behavioral Pediatrics
University of Chicago
Chicago, IL
Martin T. Stein, MD, FAAP

Professor of Pediatrics Emeritus
Developmental-Behavioral Pediatrics
University of California San Diego
Rady Children’s Hospital San Diego
San Diego, CA
Ch 18: Attention-Deficit/Hyperactivity Disorder

Assistant Professor, Department of Pediatrics
Houston, TX
Stuart W. Teplin, MD, FAAP

Developmental-Behavioral Pediatrician
Associate Professor, Emeritus
Department of Pediatrics
University of North Carolina School of Medicine
Chapel Hill, NC
Ch 13: Sensory Impairments: Hearing and Vision
xiv
Bridget Thompson, DO, FAAP

Providence, RI
Katherine A. Trier, MD, FAAP

Fellow, Developmental and Behavioral Pediatrics
Boston, MA
Sherry Sellers Vinson, MD, MEd, FAAP

Neurodevelopmental Specialist
Meyer Center for Developmental Pediatrics
Houston, TX
Ch 25: Social and Community Services for Children With Developmental Disabilities
and/or Behavioral Disorders and Their Families

Head, Section of Developmental Pediatrics
Director, Meyer Center for Developmental Pediatrics and Autism Center
Houston, TX
Ch 11: Making Developmental-Behavioral Diagnoses
Paul Wang, MD, FAAP

Deputy Director, Clinical Research
Simons Foundation
New York, NY
Associate Clinical Professor of Pediatrics
Yale University School of Medicine
New Haven, CT
Ch 2: Nature, Nurture, and Their Interactions in Child Development and Behavior
xv
Lynn Mowbray Wegner, MD, FAAP

Clinical Professor, Emerita
University of North Carolina School of Medicine
Chapel Hill, NC
Ch 27: Billing and Coding for Developmental and Behavioral Problems
in Outpatient Primary Care
Carol C. Weitzman, MD, FAAP

Professor of Pediatrics and Child Study Center
Director, Developmental-Behavioral Pediatrics
Yale School of Medicine
New Haven, CT
Reviewers
5
Board of Directors Reviewer
David I. Bromberg, MD, FAAP
Committees, Councils, and Sections

Committee on Bioethics
Committee on Coding and Nomenclature
Committee on Continuing Medical Education
Committee on Drugs
Committee on Medical Liability and Risk Management
Committee on Nutrition
Committee on Psychosocial Aspects of Child and Family Health
Committee on Substance Use and Prevention
Council on Children With Disabilities
Council on Early Childhood
Council on Environmental Health
Council on Genetics
Council on School Health
Disaster Preparedness Advisory Council
Private Payer Advocacy Advisory Committee
Section on Breastfeeding
Section on Gastroenterology, Hepatology, and Nutrition
Section on Home Care
Section on Ophthalmology
Section on Oral Health
Section on Otolaryngology–Head and Neck Surgery
Section on Pediatric Pulmonology and Sleep Medicine
Section on Urology
Surgery Advisory Panel
Contents
5
CHAPTER 1
Child Development: The Basic Science of Pediatrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CHAPTER 2
Nature, Nurture, and Their Interactions in Child Development and Behavior. . . . . . . . . . . . . . . . . .5
Paul Wang, MD, FAAP
CHAPTER 3
Environmental Influences on Child Development and Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Pamela C. High, MD, FAAP
Carrie Kelly, MD, FAAP
Angelica Robles, MD, FAAP
Bridget Thompson, DO, FAAP
Benard P. Dreyer, MD, FAAP
CHAPTER 4
Biological Influences on Child Development and Behavior and Medical
Evaluation of Children With Developmental-Behavioral Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Austin A. Larson, MD
Ellen R. Elias, MD, FAAP, FACMG
CHAPTER 5
Interviewing and Counseling Children and Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Prachi E. Shah, MD, MS
Julie Ribaudo, LMSW, IMH-E(IV)
CHAPTER 6
Early Intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Jennifer K. Poon, MD, FAAP
CHAPTER 7
Basics of Child Behavior and Primary Care Management of
Common Behavioral Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Mary E. Pipan, MD, FAAP
xviii
Contents
CHAPTER 8
Development and Disorders of Feeding, Sleep, and Elimination. . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Marie Reilly, MD
Alison Schonwald, MD, FAAP
CHAPTER 9
Developmental and Behavioral Surveillance and Screening Within
the Medical Home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Paul H. Lipkin, MD, FAAP
CHAPTER 10
Developmental Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Mary L. O’Connor Leppert, MB, BCh, FAAP
CHAPTER 11
Making Developmental-Behavioral Diagnoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
CHAPTER 12
Social and Emotional Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
John C. Duby, MD, FAAP, CPE
CHAPTER 13
Sensory Impairments: Hearing and Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Desmond P. Kelly, MD, FAAP
Stuart W. Teplin, MD, FAAP
CHAPTER 14
Motor Development and Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Catherine Morgan, PhD
Michael E. Msall, MD, FAAP
CHAPTER 15
Cognitive Development and Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Jill J. Fussell, MD, FAAP
Ann M. Reynolds, MD, FAAP
CHAPTER 16
Speech and Language Development and Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Angela C. LaRosa, MD, MSCR, FAAP
Shruti Mittal, MD, FAAP
CHAPTER 17
Learning Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Jason M. Fogler, MA, PhD
xix
Contents
CHAPTER 18
Attention-Deficit/Hyperactivity Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Michael I. Reiff, MD, FAAP
Martin T. Stein, MD, FAAP
CHAPTER 19
Autism Spectrum Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
CHAPTER 20
Interpreting Psychoeducational Testing Reports, Individualized Family
Service Plans (IFSP), and Individualized Education Program (IEP) Plans. . . . . . . . . . . . . . . . . . . . . 477
Mary C. Kral, PhD
CHAPTER 21
Disruptive Behavior Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Elizabeth B. Harstad, MD, MPH
CHAPTER 22
Anxiety and Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Viola Cheung, DO, FAAP
Michele L. Ledesma, MD, FAAP
Carol C. Weitzman, MD, FAAP
CHAPTER 23
Basics of Psychopharmacological Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Eugenia Chan, MD, MPH, FAAP
Katherine A. Trier, MD, FAAP
Peter J. Chung, MD, FAAP
CHAPTER 24
Complementary Health Approaches in Developmental
and Behavioral Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
CHAPTER 25
Social and Community Services for Children With Developmental
Disabilities and/or Behavioral Disorders and Their Families. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591
Dinah L. Godwin, MSW, LCSW
Sherry Sellers Vinson, MD, MEd, FAAP
xx
Contents
CHAPTER 26
Transition to Adult Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
Kruti R. Acharya, MD, FAAP
Stephen H. Contompasis, MD, FAAP
CHAPTER 27
Billing and Coding for Developmental and Behavioral Problems
in Outpatient Primary Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
Lynn Mowbray Wegner, MD, FAAP
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641
1
CHAPTER 1
Child Development: The Basic Science of Pediatrics

5
More than 50 years ago, Julius B. Richmond, MD, characterized child development as
the basic science of pediatrics.1 The processes of child development and behavior affect
all primary pediatric health care professionals* and pediatric subspecialists, and these
fundamentally differentiate pediatrics from all other areas of medicine. In addition to
being experts in childhood wellness and illness, parents expect primary pediatric health
care professionals to be experts in all aspects of childhood and adolescence, especially in
the domains of development and behavior. Thus, clinical competence in child develop-
ment and behavioral health is vital to the success of all pediatric health care encounters.
Despite child development’s role as the basic science of pediatrics, the Accreditation
Council for Graduate Medical Education unfortunately requires all pediatric residents
to receive a total of only 32 half-day sessions’ experience in developmental-behavioral
pediatrics during their residency training.2 Thus, even though most practicing primary
care general pediatricians will rarely step inside a pediatric or neonatal critical care unit
or even provide direct care for hospitalized patients after they have graduated from resi-
dency, they will rarely make it through even a half-day in their general pediatric prac-
tices without a question from a parent about a child’s development or behavior, for which,
unfortunately, they are required to receive a total of only 16 days of training. This clearly
represents a distressing mismatch between the amount of training and future demands
in daily pediatric practice.3 Given this limited experience, it is not unexpected that sur-
veys of pediatricians in practice continue to indicate that pediatricians feel ill-prepared
in this distinguishing domain of pediatric practice.4,5 In addition, family medicine resi-
dents, family and pediatric nurse practitioners, and physician assistants, who will provide
medical homes for at least one-third of all children in the United States,6 generally receive
little, if any, training in this basic science. As illustrated in Table 1.1, and even more con-
cerning in this setting of limited training, developmental disorders are the most preva-
lent chronic medical conditions encountered in primary care, and psychosocial and
behavioral issues are even more ubiquitous in day-to-day pediatric practice.7–9
* Throughout this manual, the term primary pediatric health care professionals is intended to
encompass pediatricians, family physicians, nurse practitioners, and physician assistants who
provide primary care to infants, children, and adolescents.
2
American Academy of Pediatrics Developmental and Behavioral Pediatrics
Table 1.1. Prevalence of Developmental-Behavioral Disorders and Other Chronic Medical

Conditions in Childrena
Condition Prevalence
Slower learning (IQ between 70 and 89) 23%
Asthma 8.4%
Learning disabilities 7.7%
Attention-deficit/hyperactivity disorder 6.7%
Other developmental delays/intellectual disabilities 4.4%
Autism spectrum disorder 1.5%
Epilepsy 1%
Congenital heart disease 1%
Cerebral palsy 0.4%
Inflammatory bowel disease 0.4%
Juvenile rheumatic diseases 0.4%
Diabetes 0.2%
Cancer 0.02%
Cystic fibrosis 0.04%
Chronic renal disease 0.008%
a
Data derived from Boyle CA, Boulet S, Schieve LA, et al. Trends in the prevalence of developmental disabilities in US children,
1997–2008. Pediatrics. 2011;127(6):1034–1042; Christensen DL, Baio J, Van Naarden Braun K, et al. Prevalence and characteristics
of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network,
11 sites, United States, 2012. MMWR Surveill Summ. 2016;65(3):1–23; and Centers for Disease Control and Prevention National
Center for Health Statistics. http://www.cdc.gov/nchs. Accessed January 18, 2018.
Of the 118,292 pediatricians currently certified by the American Board of Pediatrics,

only 775 are subspecialty board-certified in Developmental-Behavioral Pediatrics
and only 255 are subspecialty board-certified in Neurodevelopmental Disabilities.10
This does not represent 1,030 different subspecialists, as some individuals have both
certifications. To illustrate the critical dearth of developmental-behavioral subspecial-
ists, consider that congenital heart disease affects approximately 1% of the pediatric
population. Currently, there are 3,218 board-certified pediatric cardiologists to care
for these children.10 However, if this is the number of subspecialists required to provide
subspecialty care for this 1% of the population, then it would require nearly 80,000
board-certified developmental-behavioral pediatricians (not the current 775) to pro-
vide the same level of subspecialty care for the approximately 25% of the pediatric
population with developmental-behavioral concerns (see Table 1.1).
This combination of a very high prevalence of developmental-behavioral disorders

and an enormously critical shortage of subspecialists to whom patients may be referred
creates extremely long waiting lists at tertiary care developmental-behavioral evalua-
tion centers; this makes subspecialty referral a futile proposition for the vast majority
of children with developmental or behavioral concerns.3 Thus, most children with
developmental or behavioral concerns must be managed within their primary care
medical homes. Clinical judgment and confidence in evaluation and management of
3
Chapter 1: Child Development: The Basic Science of Pediatrics
developmental-behavioral concerns need to be considered as basic to general pediatric

practice as are evaluation and management of asthma and other common chronic
medical conditions encountered daily in pediatric practice.3
This second edition of American Academy of Pediatrics Developmental and Behavioral

Pediatrics continues to represent a cooperative effort of the American Academy of
Pediatrics Section on Developmental and Behavioral Pediatrics and Council on Chil-
dren With Disabilities. While it certainly cannot provide the experiential learning that
an expansion of required subspecialty exposure to developmental-behavioral pediatrics
during pediatric or family medicine residency training or in the training of future
primary care nurse practitioners or physician assistants would provide, given the crucial
need to enhance the education of all primary pediatric health care professionals in this
basic science of pediatrics, this manual attempts to blend the overlapping perspectives
of both Neurodevelopmental Disabilities and Developmental-Behavioral Pediatrics
with the goal of improving care for all children.
Finally, this manual is intended to be neither an exhaustive reference geared for the
subspecialist nor a cursory introductory list of developmental and behavioral pediatric
topics. Instead, this expanded second edition aims to be a resource that provides the
essentials of what all primary pediatric health care professionals need to know to
successfully care for children with developmental and behavioral concerns in their
practices and to identify those who truly require subspecialty referral. It is hoped that
with the assistance of this manual, primary pediatric health care professionals will
gain more confidence in evaluating and managing children with developmental and
behavioral concerns and provide evidence-based developmental-behavioral pediatric
care within the medical home.
References
1. Richmond JB. Child development: a basic science for pediatrics. Pediatrics. 1967;39(5):649–658
2. Accreditation Council for Graduate Medical Education Program Requirements for Graduate
Medical Education in Pediatrics. http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/
320_pediatrics_2017-07-01.pdf?ver=2017-06-30-083432-507. Accessed January 18, 2018
3. Voigt RG, Accardo PJ. Formal speech-language screening not shown to help children. Pediatrics.
2015;136(2):e494–e495
4. Sices L, Feudtner C, McLaughlin J, Drotar D, Williams M. How do primary care physicians identify young
children with developmental delays? A national survey. J Dev Behav Pediatr. 2003;24(6):409–417
5. Halfon N, Regalado M, Sareen H, et al. Assessing development in the pediatric office. Pediatrics.
2004;113(6)(suppl 5):1926–1933
6. Phillips RL, Bazemore AW, Dodoo MS, Shipman SA, Green LA. Family physicians in the child health
care workforce: opportunities for collaboration in improving the health of children. Pediatrics.
2006;118(3):1200–1206
7. Boyle CA, Boulet S, Schieve LA, et al. Trends in the prevalence of developmental disabilities in US children,
1997–2008. Pediatrics. 2011;127(6):1034–1042
8. Christensen DL, Baio J, Van Naarden Braun K, et al. Prevalence and characteristics of autism spectrum
disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network,
11 sites, United States, 2012. MMWR Surveill Summ. 2016;65(3):1–23
9. Centers for Disease Control and Prevention National Center for Health Statistics. http://www.cdc.gov/nchs.
Accessed January 18, 2018
10. American Board of Pediatrics, Inc. Pediatric Physicians Workforce Data Book 2015-2016. Chapel Hill, NC:
American Board of Pediatrics, Inc; 2016
5
CHAPTER 2
Nature, Nurture, and Their Interactions in

Child Development and Behavior
Paul Wang, MD, FAAP
5
Nature and nurture have long been regarded as rival influences on child development
and behavior. One school of thought has contended that a child’s behaviors and devel-
opmental outcome are determined by nature—that is, by innate biology—while a rival
school has argued that nurture—a child’s environment and experiences—is dominant in
determining the child’s developmental outcome. While the nature-nurture debate raged
among academics, intuitive parents and primary pediatric health care professionals have
long known that both sets of factors—the innate and the experiential—are important in
the complex processes of child development and behavior. Over the last several decades,
science has amassed substantial evidence to document the importance of both nature
and nurture.1 Moreover, current research is elucidating the complex ways in which
nature and nurture interact throughout the childhood years.
This chapter attempts to provide a framework in which to consider how nature, nurture,
and their interactions shape children’s lives. Many examples are provided of both innate
and experiential factors that influence children’s development and behavior, and of the
mechanisms through which those factors are believed to act. Throughout the chapter, the
reader is asked to hold 2 overarching concepts in mind: individual variability and devel-
opmental plasticity. Because of individual variability, children differ in how any factor
may shape their development and behavior regardless of whether that factor is innate
or environmental. As research is beginning to show, much of this variability may be
rooted in the interaction of nature and nurture, also known as gene by environment
interaction or GxE. Because of developmental plasticity, the effects of both innate and
experiential factors can be either augmented or ameliorated by other factors over time.
No developmental influence, whether innate or environmental, should be regarded as
deterministic, strictly consigning a child to a certain fate. Rather, the processes of devel-
opment continue throughout childhood, adolescence, and even adulthood, allowing
biological and behavioral interventions to shape later outcomes.
6
Innate Factors in Child Development and Behavior

Nature can be variably construed in either a narrow or a broad manner. From the
narrow perspective, a child’s nature is defined as the child’s innate biological endow-
ment and heredity and, thus, consists primarily of genetics. From the broader perspec-
tive, all factors that are believed to operate through a direct biological mechanism are
construed as being within the category of nature.
Genetics
Research on the influence of nature on children’s behavior and development started in
earnest with twin studies, which examine the resemblance of monozygotic (identical)
twins to each other and the resemblance of dizygotic (fraternal) twins to each other.
Data from these twin studies are commonly summarized in a numerical parameter
known as heritability, which can range from 0 to 1.00 and is symbolized as h2. For
example, studies of attention-deficit/hyperactivity disorder (ADHD) estimate its
heritability to be between 0.60 and 0.90, while IQ studies estimate the heritability
of intelligence 0.50 to 0.85 with values tending higher with increasing age (ie, genetic
factors have a larger influence in older ages).2 It should be understood that heritability
is an abstract mathematical parameter that does not translate easily to tangible inter-
pretation. That is, if the heritability of reading disability is 0.75, it does not imply that
75% of all cases of dyslexia have an exclusively genetic etiology, or that the child of a
person with dyslexia has a 75% chance of having dyslexia, or any such implication.
Heritability merely describes the proportion of the statistical variance in a trait that
was attributable to genetics in a particular research study.
Behavioral genetic studies commonly yield estimates of heritability that are greater
than 0.50 for many developmental-behavioral diagnoses and traits,3 leading some
commentators to claim that biology is more important than environment. Such a claim
is misleading at best. First, the word more is confusing in this context. Even when the
estimate of heritability is high, it cannot be concluded that any particular case of a
disease is “more” caused by genetic or environmental factors or that more cases of that
disease are caused by genetics than environment. Since no study of any trait has shown
complete genetic heritability (ie, heritability has always been found to be <1.00), and
since even identical twins do not show 100% concordance for any diagnosis or trait
(eg, autism, schizophrenia, reading skills; Figure 2.1), it implies that environmental
factors can make a clinically significant difference even when 2 individuals are geneti-
cally identical. It seems much more likely that all or almost all cases of a disease have
both genetic and environmental influences in their pathogenesis. Robert Plomin, one
of the most prominent researchers in the field, has commented that behavioral genetic
studies can be regarded as providing some of the best evidence of the importance of
environmental factors in shaping health and disease.4
A further argument against the overinterpretation of heritability parameters is that they

are dependent on the amounts of genetic and environmental variation in the popula-
tions under study. For example, if all the subjects in a study had identical environments,
7
Chapter 2: Nature, Nurture, and Their Interactions in Child Development and Behavior
90
MZ
80
DZ
70
Twin Concordance
60
50
40
30
20
10
0
Reading Language Maths Schizophrenia Depression Alcoholism
Learning Difficulties Psychiatric Disorders
Figure 2.1. Twin concordances for learning disabilities and for psychiatric disorders.
Abbreviations: MZ, monozygotic; DZ, dizygotic.
Reproduced from Haworth C, Plomin R. Quantitative genetics in the era of molecular genetics: learning abilities and
disabilities as an example. J Am Acad Child Adolesc Psychiatry. 2010;49(8):783–793, with permission from Elsevier.
the study would show misleadingly high estimates of genetic heritability and low esti-
mates of environmental influence. In fact, it is well known that extreme environmental
manipulation can have enormous effects on behavior and development. Common, real-
life variability in the environment also affects estimates of heritability, as Turkheimer
and colleagues5 demonstrated. They found that estimates of the heritability of IQ are
higher in populations with higher socioeconomic status (SES), while heritability is near
zero in populations of lower SES. Explanations for this finding are only speculative, but
it seems possible that families with higher SES provide a more consistently beneficial
environment to their children, thus minimizing the environmental differences between
them and thereby making genetics a larger source of variance. In populations with
lower SES, on the other hand, some children may encounter more beneficial environ-
ments (eg, a particularly nurturing teacher) while others do not, which results in
higher estimates of environmental variance in IQ and minimal genetic heritability.
With the advent of molecular genetic methods, twin studies have been supplanted by
research that examines specific genes and their effects on child behavior and develop-
ment. Genome-wide association studies (GWASs) provide one example of this new
approach. In these studies, single nucleotide polymorphisms, which are commonly
found in the general population, are studied in relation to phenotypic traits. In general,
GWASs are suited to finding genetic differences that are relatively common but have
relatively weak effects on the risk of having a medical condition, whether that disease is
emphysema or a reading disability. More recently, next-generation genetic sequencing
methods have been applied to the task of finding the genetic roots of behavior and
development. These methods include whole exome sequencing and whole genome
sequencing, in which every base pair in a person’s genome is sequenced, whether it
8
is found in an exon, in an intron, or in the intervening segments that comprise 98% of

our DNA (formerly referred to as “junk DNA”). These “next-gen” studies are finding
variations that are rare in the population as a whole but that may carry much stronger
disease risk.6 (It is reasoned that if a genetic difference carried a high risk for a serious
medical condition, then it could not be common in the population, as it would decrease
the fitness of individuals who have it.) Even when differences in genotype are found,
science is faced with the daunting task of understanding how these differences in
genetic sequence give rise to seemingly dramatic phenotypic differences. Genes and
their protein products interact in enormously complex networks, regulating the
expression and effect of other genes and proteins, and scientists will be busy for
many decades unraveling this complexity.
Genetic factors can have either large or subtle influences on child development and
behavior. Examples of the former include genetic diagnoses that are associated with
intellectual disability or severe behavioral abnormalities. These disorders can result
from single gene mutations (eg, in the FMR1, HPRT1, or MECP2 genes associated with
fragile X syndrome, Lesch-Nyhan syndrome, and Rett syndrome, respectively) or from
genetic conditions that affect multiple genes (eg, contiguous gene deletion syndromes
such as Williams syndrome or velocardiofacial syndrome, chromosomal aneuploidies
such as Down syndrome and segmental chromosomal deletions or duplications). In some
of these disorders, the exact pathogenic mechanism is not fully understood. For example,
it is still not conclusively known which genes on the triploid chromosome 21 have signif-
icant roles in causing the neurobiological differences associated with Down syndrome.
In other disorders, including fragile X syndrome and many metabolic conditions, such
as Lesch-Nyhan syndrome, the pathogenesis is understood to a greater extent.
In contrast to the large effects of mutations in genes such as FMR1, HPRT1, and MECP2,
mutations and variants in other genes are believed to have more subtle effects on the
risk for conditions such as reading disability, ADHD, and other learning disabilities.
For some conditions, such as autism spectrum disorder (ASD), research suggests that
there are both large-effect and small-effect genes. Mutations in the SHANK3 and CHD8
genes, for example, are associated with a large risk for autism, but mutations in large-
effect genes such as these are estimated to account for only 30% to 40% of all cases of
ASD, at most, while most cases of ASD are believed to be associated with small-effect
mutations or common variants in other genes.7 These genetic differences may not give
rise to autism on their own but may work with other genetic risk factors or with yet-
unspecified environmental factors to cause autism. Because of the smaller effects of
these genes, however, and their complex interactions with other factors, they have
been difficult to identify and to confirm.
Individual variability in clinical manifestations is present both for small-effect common

variant genetic differences but also for the large-effect genes. For instance, only 25% to
30% of individuals with fragile X syndrome, associated with the FMR1 gene, meet full
diagnostic criteria for autism. Even the level of intellectual disability seen in fragile
X syndrome varies widely among those with the full mutation. Similarly, mutations in
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SUPREME COURT OF THE UNITED STATES.
Chief Associate State Term of Years Born. Died.
Justices. Justices. Whence Service. of
Appointed. Service.
1 John Jay[117] New York 1789– 6 1745 1829
1795
John South 1789– 2 1739 1800
Rutledge[117] Carolina 1791
William Massachusetts 1789– 21 1733 1810
Cushing 1810
James Wilson Pennsylvania 1789– 9 1742 1798
1798
John Blair[117] Virginia 1789– 7 1732 1800
1796
Robert H. Maryland 1789– 1 1745 1790
Harrison[117] 1790
James Iredell North 1790– 9 1751 1799
Carolina 1799
Thomas Maryland 1791– 2 1732 1819
Johnson[117] 1793
William New Jersey 1793– 13 1745 1806
Patterson 1806
2 John South 1795– 1739 1800

Rutledge[118] Carolina 1795
Samuel Chase Maryland 1796– 15 1741 1811
1811
3 Oliver Connecticut 1796– 5 1745 1807

Ellsworth[117] 1801
Bushr’d Virginia 1798– 31 1762 1829
Washington 1829
Alfred North 1799– 5 1755 1810
Moore[117] Carolina 1804
4 John Marshall Virginia 1801– 34 1755 1835

1835
William South 1804– 30 1771 1834
Johnson Carolina 1834
Brockh’t New York 1806– 17 1757 1823
Livingston 1823
Thomas Todd Kentucky 1807– 19 1765 1826
1826
Joseph Story Massachusetts 1811– 34 1779 1845
1845
Gabriel Maryland 1811– 25 1752 1844
Duval[117] 1836
Smith New York 1823– 22 1767 1845
Thompson 1845
Robert Kentucky 1826– 2 1777 1828
Trimble 1828
John McLean Ohio 1829– 32 1785 1861
1861
Henry Baldwin Pennsylvania 1830– 16 1779 1846
1846
James M. Georgia 1835– 32 1790 1867
Wayne[119] 1867
5 Roger B. Taney Maryland 1836– 28 1777 1864

1864
Philip P. Virginia 1836– 5 1783 1841
Barbour 1841
John Catron Tennessee 1837– 28 1778 1865
1865
John McKinley Alabama 1837– 15 1780 1852
1852
Peter V. Daniel Virginia 1841– 19 1785 1860
1860
Samuel New York 1845– 27 1792 1873
Nelson[117] 1872
Levi Woodbury New 1845– 6 1789 1851
Hampshire 1851
Robert C. Pennsylvania 1846– 23 1794 1870
Grier[117] 1869
Benjamin R. Massachusetts 1851– 6 1809 1874
Curtis[117] 1857
John A. Alabama 1853– 8 1811
Campbell[117] 1861
Nathan Maine 1858– 1803 1881
Clifford
Noah H. Ohio 1861– 1805 1881
Swayne[117]
Samuel F. Iowa 1862– 1816
Miller
David Illinois 1862– 15 1815
Davis[117] 1877
Stephen J. California 1866– 1816
Field
6 Salmon P. Ohio 1864– 9 1808 1873

Chase 1873
William Pennsylvania 1870– 10 1808
Strong[117] 1880
Joseph P. New Jersey 1870– 1813
Bradley
Ward Hunt[117] New York 1872– 1811
7 Morrison R. Ohio 1874– 13 1816 1887

Waite 1887
John M. Kentucky 1877– 1833
Harlan
William B. Georgia 1880– 1826
Woods
Horace Gray Massachusetts 1881–
Roscoe New York 1882– .
Conkling[117]
Samuel New York 1882–
Blatchford
8 Melville W. Illinois 1887–

Fuller
Lucius Q. C. Mississippi 1887–
Lamar
David J. Kansas 1890–
Brewer
TOTAL NUMBER OF TROOPS CALLED INTO
[120]
SERVICE DURING THE REBELLION.
The various calls of the President for men were as follows:
1861—3 months’ men 75,000

1861—3 years’ men 500,000
1862—3 years’ men 300,000
1862—9 months’ men 300,000
1864—3 years’ men, February 500,000
1864—3 years’ men, March 200,000
1864—3 years’ men, July 500,000
1864—3 years’ men, December 300,000
Total 2,675,000
LENGTH OF SESSIONS OF CONGRESS, 1789–1891.
No. of Congress. No. of Session. Time of Session.
1st March 4, 1789—September 29, 1789
1st 2d January 4, 1790—August 12, 1790
3d December 6, 1790—March 3, 1791
1st October 24, 1791—May 8, 1792
2d
2d November 5, 1792—March 2, 1793
1st December 2, 1793—June 9, 1794
3d
4th
1st May 15, 1797—July 10, 1797
5th 2d November 13, 1797—July 16, 1798
1st December 2, 1799—May 14, 1800
6th
1st December 7, 1801—May 3, 1802
7th
1st October 17, 1803—March 27, 1804
8th
1st December 2, 1805—April 21, 1806
9th
1st October 26, 1807—April 25, 1808
10th
1st May 22, 1809—June 28, 1809
11th 2d November 27, 1809—May 1, 1810
1st November 4, 1811—July 6, 1812
12th
1st May 24, 1813—August 2, 1813
13th 2d December 6, 1813—April 18, 1814
3d September 19, 1814—March 3, 1815
14th
15th
1st December 6, 1819—May 15, 1820
16th
1st December 3, 1821—May 8, 1822
17th
1st December 1, 1823—May 27, 1824
18th
19th 1st December 5, 1825—May 22, 1826
1st December 3, 1827—May 26, 1828
20th
1st December 7, 1829—May 31, 1830
21st
1st December 5, 1831—July 16, 1832
22d
23d
24th
1st September 4, 1837—October 16, 1837
25th 2d December 4, 1837—July 9, 1838
26th
1st May 31, 1841—September 13, 1841
27th 2d December 6, 1841—August 31, 1842
28th
1st December 1, 1845—August 10, 1846
29th
30th
1st December 3, 1849—September 30, 1850
31st
32d
33d
34th 2d August 21, 1856—August 30, 1856
35th
36th
1st July 4, 1861—August 6, 1861
37th 2d December 2, 1861—July 17, 1862
38th 1st December 7, 1863—July 4, 1864
39th
1st March 4, 1867—March 30, 1867
„ July 3, 1867—July 20, 1867
40th „ November 21, 1867—December 2, 1867
2d December 2, 1867—July 27, 1868
1st March 4, 1869—April 23, 1869
41st 2d December 6, 1869—July 15, 1870
1st March 4, 1871—April 20, 1871
42d 2d December 4, 1871—June 10, 1872
43d
44th
1st October 15, 1877—December 3, 1877
45th 2d December 3, 1877—June 20, 1878
1st March 18, 1879—July 1, 1879
46th 2d December 1, 1879—June 16, 1880
47th
48th
49th
1st December 5, 1887—October 20, 1888
50th
1st December 2, 1889—October, 1890
51st
CIVIL OFFICERS OF THE UNITED STATES
Number Employed in the several Departments of the Government, July 1st,

1882.
Executive Office 7
Congress 280
State Department 419
Treasury Department 12,130
War Department 1,861
Post-Office Department 52,672
Navy Department 128
Interior Department 2,813
Department of Justice 2,876
Department of Agriculture 77
Government Printing Office 1,168
Total 74,431
THE STATES AND TERRITORIES—when Admitted or
Organized—with Area and Population.
STATES. Date when Area in Population nearest
[First thirteen admitted on Admitted. square census to date of
ratifying Constitution—all miles at admission.
others admitted by Acts of time of
Congress.] admission. Population. Year.
Delaware December 7,
2,050 59,096 1790
1787
Pennsylvania December 12,
45,215 434,373 1790
1787
New Jersey December 18,
7,815 184,139 1790
1787
Georgia January 2,
59,475 82,548 1790
1788
Connecticut January 9,
4,990 237,496 1790
1788
Massachusetts February 6,
8,315 378,787 1790
1788
Maryland April 28, 1788 12,210 319,728 1790
South Carolina May 23, 1788 30,570 249,033 1790
New Hampshire June 21, 1788 9,305 141,885 1790
Virginia June 25, 1788 42,450 747,610 1790
New York July 26, 1788 49,170 340,120 1790
North Carolina November 21,
52,250 393,751 1790
1789
Rhode Island May 29, 1790 1,250 68,825 1790
Vermont March 4, 1791 9,565 85,339 1791
Kentucky June 1, 1792 40,400 73,077 1892
Tennessee June 1, 1796 42,050 77,202 1796
Ohio November 29,
41,060 41,915 1802
1802
Louisiana April 30, 1812 48,720 76,556 1812
Indiana December 11,
36,350 63,805 1816
1816
Mississippi December 10,
46,810 75,512 1817
1817
Illinois December 3,
56,650 34,620 1818
1818
Alabama December 14,
52,250 127,901 1820
1819
Maine March 15, 1820 33,040 298,269 1820
Missouri August 19, 1821 69,415 66,586 1821
Arkansas June 15, 1836 53,850 52,240 1836
Michigan January 26,
58,915 212,267 1840
1837
Florida March 3, 1845 58,680 54,477 1845
Iowa December 28,
56,025 81,920 1846
1846
Texas December 29,
265,780 212,592 1850
1845
Wisconsin May 29, 1848 56,040 305,391 1850
California September 9,
158,360 92,597 1850
1850
Minnesota May 11, 1858 83,365 172,023 1860
Oregon February 14,
96,030 52,465 1859
1859
Kansas January 29,
82,080 107,206 1860
1861
West Virginia June 19, 1863 24,780 442,014 1870
Nevada October 31,
110,700 40,000 1864
1864
Nebraska March 1, 1867 76,855 60,000 1867
Colorado August 1, 1876 103,926 150,000 1876
District of Columbia March 3, 1791 60
North Dakota July 4, 1889
149,100 135,177 1880
South Dakota July 4, 1889
Montana July 4, 1889 146,080 39,159 1880
Washington July 4, 1889 69,180 75,116
Idaho 84,800 32,610 1880
Wyoming 97,890 20,789 1880
TERRITORIES. Dates of Present
organization. area, Census
Population.
square of
miles.
Utah September 9,
82,090 143,963 1880
1850
New Mexico September 9,
122,580 119,565 1880
1850
Arizona February 24,
113,020 40,440 1880
1863
Indian 64,690
Alaska Unsurveyed
SPEAKERS OF THE HOUSE OF REPRESENTATIVES.
Name. State. Congress. Term of Service.
F. A Muhlenberg Pennsylvania 1st Congress. April 1, 1789, to March 4, 1791
Jonathan Trumbull Connecticut 2d „ Oct. 24, 1791, to March 4, 1793
F. A. Muhlenberg Pennsylvania 3d „ Dec. 2, 1793, to March 4, 1795
Jonathan Dayton New Jersey 4th „ Dec. 7, 1795, to March 4, 1797
„ „ „ 5th „ May 15, 1797, to March 3, 1799
Theodore Sedgwick Massachusetts 6th „ Dec. 2, 1799, to March 4, 1801
Nathaniel Macon North Carolina 7th „ Dec. 7, 1801, to March 4, 1803
„ „ „ 8th „ Oct. 17, 1803, to March 4, 1805
„ „ „ 9th „ Dec. 2, 1805, to March 4, 1807
Joseph B. Varnum Massachusetts 10th „ Oct. 26, 1807, to March 4, 1809
„ „ „ 11th „ May 22, 1809, to March 4, 1811
Henry Clay Kentucky 12th „ Nov. 4, 1811, to March 4, 1813
„ „ „ 13th „ May 24, 1813, to Jan. 19, 1814
Langdon Cheves S C., 2d Sess. 13th „ Jan. 19, 1814, to March 4, 1815
Henry Clay Kentucky 14th „ Dec. 4, 1815, to March 4, 1817
„ „ „ 15th „ Dec. 1, 1817, to March 4, 1819
„ „ „ 16th „ Dec. 6, 1819, to May 15, 1820
John W. Taylor New York, 2d Sess. 16th „ Nov. 15, 1820, to March 4, 1821
Philip P. Barbour Virginia 17th „ Dec. 4, 1821, to March 4, 1823
Henry Clay Kentucky 18th „ Dec. 1, 1823, to March 4, 1825
John W. Taylor New York 19th „ Dec. 5, 1825, to March 4, 1827
Andrew Stephenson Virginia 20th „ Dec. 3, 1827, to March 4, 1829
„ „ „ 21st „ Dec. 7, 1829, to March 4, 1831
„ „ „ 22d „ Dec. 5, 1831, to March 4, 1833
„ „ „ 23d „ Dec. 2, 1833, to June 2, 1834
John Bell Tennessee, 2d Sess. 23d „ June 2, 1834, to March 4, 1835
James K. Polk „ „ 24th „ Dec. 7, 1835, to March 4, 1837
„ „ „ „ 25th „ Sept. 5, 1837, to March 4, 1839
Robert M. T. Hunter Virginia 26th „ Dec. 16, 1839, to March 4, 1841
John White Kentucky 27th „ May 31, 1841, to March 4, 1843
John W. Jones Virginia 28th „ Dec. 4, 1843, to March 4, 1845
John W. Davis Indiana 29th „ Dec. 1, 1845, to March 4, 1847
Robert C. Winthrop Massachusetts 30th „ Dec. 6, 1847, to March 4, 1849
Howell Cobb Georgia 31st „ Dec. 22, 1849, to March 4, 1851
Linn Boyd Kentucky 32d „ Dec. 1, 1851, to March 4, 1853
„ „ „ 33d „ Dec. 5, 1853, to March 4, 1855
Nathaniel P. Banks Massachusetts 34th „ Feb. 2, 1856, to March 4, 1857
James L. Orr South Carolina 35th „ Dec. 7, 1857, to March 4, 1859
William Pennington New Jersey 36th „ Feb. 1, 1860, to March 4, 1861
Galusha A. Grow Pennsylvania 37th „ July 4, 1861, to March 4, 1863
Schuyler Colfax Indiana 38th „ Dec. 7, 1863, to March 4, 1865
„ „ „ 39th „ Dec. 4, 1865, to March 4, 1867
„ „ „ 40th „ March 4, 1867, to March 4, 1869
James G. Blaine Maine 41st „ March 4, 1869, to March 4, 1871
„ „ „ 42d „ March 4, 1871, to March 4, 1873
„ „ „ 43d „ Dec. 1, 1873, to March 4, 1875
Michael C. Kerr Indiana 44th „ Dec. 6, 1875, to Aug. 20, 1876
Samuel J. Randall Penna., 2d Sess. 44th „ Dec. 4, 1876, to March 4, 1877
„ „ „ „ 45th „ Oct. 15, 1877, to March 4, 1879
„ „ „ „ 46th „ March 18, 1879, to March 4, 1881
Warren B. Keifer Ohio 47th „ Dec. 5, 1881, to March 4, 1883
John G. Carlisle Kentucky 48th „ Dec. 3, 1883, to March 4, 1885
„ „ „ 49th „ Dec. 7, 1885, to March 4, 1887
„ „ „ 50th „ Dec. 5, 1888, to March 4, 1889
Thomas B. Reed Maine 51st „ Dec. 2, 1889, to March 4, 1891
Table, exhibiting, by States, the Aggregate Troops
called for by the President, and furnished to the
Union Army, from April 15th, 1861, to close of War of
Rebellion
Aggregate Aggregate
States and
Quota Men Paid Total reduced to a 3
Territories
furnished commutation years’ standard
Maine 73,587 70,107 2,007 72,114 56,776
New Hampshire 35,897 33,937 692 34,629 30,849
Vermont 32,074 33,288 1,974 35,262 29,068
Massachusetts 139,095 146,730 5,318 152,048 124,104
Rhode Island 18,898 23,236 463 23,699 17,866
Connecticut 44,797 55,864 1,515 57,379 50,623
New York 507,148 448,850 18,197 467,047 392,270
New Jersey 92,820 76,814 4,196 81,010 57,908
Pennsylvania 385,369 337,936 28,171 366,107 265,517
Delaware 13,935 12,284 1,386 13,670 10,322
Maryland 70,965 46,638 3,678 50,316 41,275
West Virginia 34,463 32,068 32,068 27,714
District of 13,973 16,534 338 16,872
11,506
Columbia
Ohio 306,322 313,180 6,479 319,659 240,514
Indiana 199,788 196,363 784 197,147 153,576
Illinois 244,496 259,092 55 259,147 214,133
Michigan 95,007 87,364 2,008 89,372 80,111
Wisconsin 109,080 91,327 5,097 96,424 79,260
Minnesota 26,326 24,020 1,032 25,052 10,693
Iowa 79,521 76,242 67 76,309 68,630
Missouri 122,496 109,111 109,111 86,530
Kentucky 100,782 75,760 3,265 79,025 70,832
Kansas 12,931 20,149 2 20,151 18,706
Tennessee 1,560 31,092 31,092 26,394
Arkansas 780 8,289 8,289 7,835
North Carolina 1,500 3,156 3,156 3,156
California 15,725 15,725 15,725
Nevada 1,080 1,080 1,080
Oregon 1,810 1,810 1,773
Washington 964 964 964
Nebraska 3,157 3,157
2,175
Territory
Colorado 4,903 4,903
3,697
Territory
Dakota 206 205 206
New Mexico 6,561 6,561
4,432
Territory
Alabama 2,576 2,576 1,611
Florida 1,290 1,290 1,290
Louisiana 5,224 5,224 4,634
Mississippi 545 545 545
Texas 1,965 1,965 1,632
Indian Nation 3,530 3,530 3,530
Colored 93,441 93,441 91,789
Troops[121]
Total 2,763,670 2,772,408 86,724 2,859,132 2,320,272
STATEMENT SHOWING THE EXPENDITURES,
As far as ascertained, necessarily growing out of the War of the Rebellion, from
July 1, 1861, to June 30, 1870, inclusive.

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