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Updated: Feb 4, 2026

Assessing the Coherence of Parents' Short Narratives Regarding their Child Using the Five-Minute Speech Sample Procedure
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Published on: September 19, 2019

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Child with multiple problems: Clinical complexity and uncertainty

Michael McDowell1,2,3

  • 1School of Medicine, University of Queensland, Brisbane, Queensland, Australia.

Journal of Paediatrics and Child Health
|October 9, 2018
PubMed

Insights

Navigating complex cases in neurodevelopmental-behavioural paediatrics requires clinicians to manage uncertainty effectively. This involves using shared hypotheses about biological, developmental, and transactional factors to guide patient care.

Area of Science:

  • Neurodevelopmental-behavioural paediatrics
  • Clinical practice

Background:

  • Clinicians face challenges interpreting research evidence in daily practice.
  • Childhood neurodevelopmental disorders present with inherent complexity, heterogeneity, and comorbidity.
  • Uncertainty is a constant factor due to individual social contexts.

Purpose of the Study:

  • To examine the clinical challenges in neurodevelopmental-behavioural paediatrics.
  • To offer strategies for effectively managing complexity and uncertainty.
  • To promote efficient clinical decision-making within knowledge limitations.

Main Methods:

  • Conceptual analysis of clinical challenges.
  • Proposal of a hypothesis-driven approach.
  • Emphasis on systematic testing and revision of clinical hypotheses.

Main Results:

  • Effective management of uncertainty is prioritized over its elimination.
  • A framework is suggested for addressing complexity by considering biological, developmental, and transactional components.
  • Hypotheses are proposed as shared tools within the child's care system.

Conclusions:

  • Clinicians should embrace uncertainty as inherent to practice.
  • A systematic, hypothesis-testing approach aids in longitudinal care.
  • Integrating biological, developmental, and transactional factors improves patient management.

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