Why might I need a pediatric developmental specialist for my child?

In short, because parents know when their child might not be developing as he or she should, or if he or she has weaknesses impacting their early developmental or education. Studies show that when children are found to have Developmental Delays or Autism Spectrum Disorder, more than 90% of parents had concerns. While it can be scary, and certainly anxiety provoking to ask if your concerns about your child’s development are legitimate, as a parent, it is far more alarming to find out you ignored your early suspicions. Parents KNOW!

What ages does GCADP treat?

Dr. Moncino, GCADP’s founder, sees toddlers, children, pre-teens, teens and young adults—from 15-months to the mid 20’s.

What conditions does GCADP treat?

Dr. Moncino brings nearly 40 years of pediatric and adolescent medical care, practical experience and in-depth knowledge of scientific evidence to help parents and their children address all-too-common developmental and behavioral problems in toddlers, children, teens and young adults.

We provide evaluation, diagnosis and evidence-based medical treatment for:

• Autism Spectrum Disorder (ASD)
• Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADD/ADHD) or concerns regarding the core symptoms of ADD/ADHD (hyperactivity, inattention, distraction, impulsivity, and lack of follow-through), regardless of age, or previous or underlying medical or behavioral health diagnosis
• Complicated toilet-training issues, enuresis (bedwetting), and encopresis (soiling)
• Anxiety, adjustment disorders and depression
• Learning disorders, including dyslexia and other school-related challenges
• Regulatory disorders, such as feeding problems or sleep disorders
• Speech and language delays
• Tics, Tourette syndrome and other habit disorders
• All forms of challenging behaviors in school-aged children and teens, manifested as irritability, anger, aggression, low frustration tolerance or problem behaviors, and discipline difficulties that result either in-home disruptions or a drop in school performance
• Preschool disruptive behaviors or dysregulated emotional states, manifested as hyperactivity or short attention span, excessive running or climbing, or impulsive or risk-taking behavior of lack of follow-through and aggressive behaviors

Which developmental issues are most common at which age?

Typically, Dr. Moncino sees toddlers (1 to 3-year-olds) for concerns about developmental delays, Autism Spectrum Disorder (ASD), temper tantrums, feeding problems and sleep problems. Once kids reach preschool and school-age, concerns regarding Learning Disabilities (LD), ADD/ADHD, as well as anxiety and depression also emerge. As children reach middle school and older, most of the patients he sees have an established diagnosis of, or concerns about ASD, ADD/ADHD, LD, anxiety and/or depression.

Do I need a PCP (primary care physician) to see Dr. Moncino?

Every child, teen and young adult needs established and ongoing care with a PCP for routine preventive care, sick visits, immunizations, and urgent/emergency medical care. But you don’t need a referral from your PCP to see Dr. Moncino.

How will Dr. Moncino work with my PCP to care for my child?

While your PCP will continue to provide all routine pediatric care and oversees your child’s medical home, Dr. Moncino oversees your child’s DBP specialty care team focused on ASD or DBP disorders, working collaboratively with your child’s pediatrician or young adult’s PCP.

What is your treatment philosophy?

Central to Dr. Moncino’s philosophy is that all children “ do well if they can.” Accordingly, Dr. Moncino’s treatment plans focus on building on your child’s strengths and accommodating weaknesses to achieve the most productive, accomplished and happy life possible. To do this, Dr. Moncino is committed to cultivating a close relationship with you and your family. He views his role as partnering with parents to address the challenges that get in the way of their child’s success. Using best practices from models of change management, Dr. Moncino meets children at their current developmental level, guiding them (and you) through change in small increments toward the goals you and Dr. Moncino have agreed on as part of their treatment plan. And here’s the key: incremental changes over time do lead to success. Just like compound interest yields a far larger payout in the long run, your child can accomplish amazing things over time, based on the carefully considered changes you and Dr. Moncino are working on with your child today. While the definition of success is different for every child, working together we can help your child become the best he/she can. Behavioral change is hard; it is slow, but it can happen! Dr. Moncino looks forward to working with you and your son or daughter along this journey.

What if my child needs speech, occupational, physical or feeding therapy?

Dr. Moncino will write referrals for speech, occupational, physical or feeding therapy, if needed. He’ll also work with these therapists, and incorporate their findings and care into your child’s treatment program.

What if my child needs to see a psychologist or psychiatrist?

if your child would benefit from seeing a psychologist, Dr. Moncino will help you with that process and work with the psychologist in caring for your child. Dr. Moncino’s expertise in medication management for the disorders he treats is broad, but if he ever feels it is in your child’s best interest to see a psychiatrist, he can help you identify one to join your child’s care team. Or, if you already have a psychiatrist for your child, Dr. Moncino will work with him/her in treating your child.

Will Dr. Moncino work with my school’s IEP team?

Yes. The education system is involved with your child’s care for seven to eight hours per day and, at times, longer. Especially once children are older than 4 or 5, the services your child receives through school may very well be the only services he or she receives. The educational system can be confusing and complex and, while fully separate from the medical system, Dr. Moncino views it as one of his central roles to work with you and school team to assure your child has the support he or she needs for maximal success, academically and socially.

How will Dr. Moncino help my whole family cope with my child’s disorder?

As the parent of two kids with developmental disorders—and having discovered his own dyslexia at the tender age of 45—Dr. Moncino knows firsthand the impact on the entire family. An ASD or DBP diagnosis doesn’t just impact the child; it impacts the entire family involved in the child’s care: parents, sibling’s, grandparents, nannies, even carpool parents and coaches, etc. Raising a child is not an individual sport—it takes many people, in many different roles, over many years to help children learn and master academics, instruments, sports and interpersonal relationships. It takes the same group of adults—and many others—to help children with developmental weaknesses achieve their full potential. Dr. Moncino will partner with you and the other adults in the child’s life to address the challenges that get in the way of his or her success.

Can I still see my own therapists?

Absolutely! If your child is already seeing a therapist, don’t stop. Dr. Moncino will work with him/her to coordinate services and support your child. If your child doesn’t currently see a therapist, and Dr Moncino believes it would be beneficial, he will tell you. And if at any time Dr. Moncino feels your child needs additional support—or changes to the therapy plan—he’ll discuss these with you for your consideration.

Can you explain the different developmental disorders you treat?

DEVELOPMENTAL DELAY (DD), GLOBAL DEVELOPMENTAL DELAY (GDD) AND SPEECH LANGUAGE DISORDERS (SLD). DD, GDD and SLD in toddlers and preschoolers is when the child’s development isn’t where it should be for his/her chronological age. There are five domains (or general areas) in a child’s development: a) motor skills, b) communication skills, c) cognitive skills, d) adaptive (self-care) skills, and e) personal-social skills. In SLD, the delays are limited to the child’s speech, language or communication domain. In DD and GDD, at least two of the five domains are impacted. If your child has been evaluated by Babies Can’t Wait or the educational system, they may use the terms Significant Developmental Delay (SDD) instead of GDD or Speech Language Impairment (SLI) instead of SLD Regardless of the name used to describe your child’s delay(s), taking a wait-and-see approach in young children is never the answer. An evaluation is of the utmost importance to try to identify a cause for the delay as early identification and intervention is clearly the best road to helping your child. The earlier we identify a delay, the earlier we can start to treat your child. It can be very difficult to identify the exact cause of delays in young children, and too often we never find the “why.” Yet, regardless of whether we can identify the cause of your child’s delays, it’s critical to implement scientifically-proven interventions to help your toddler and preschooler catch up to his/her peers. We’ll say it again: time truly is of the essence in these youngest children. No parent wants their child to have developmental problems. But every parent is looking for ways to help their child. Dr. Moncino’s goal is to help you help your child to the fullest extent possible. AUTISM SPECTRUM DISORDER (ASD): ASD is the most common and, at the same time, the most confusing neurodevelopmental disorder in childhood. It is complex and highly variable. Most parents, educators, and frankly even those in the medical field, think about ASD as a very typical disorder. Yet the clinical variation between two children or, for that matter, two adults of the same age both of whom have ASD can be worlds apart. In 2014, Dr. Moncino started to care for children and teens with ASD nearly 90% of his time. Since then, he has diagnosed more than 500 children with ASD and provided comprehensive ASD care for more than 700. Dr. Moncino provides comprehensive developmental medical care for children, teens and young adults with ASD. This includes assessments and evaluations for ASD but more importantly, he manages their care, helps you understand the disorder and how to help your child, develops a treatment plan, and works collaboratively with all those involved in your child’s/teen’s care. Dr. Moncino, doesn’t restrict his practice to those with a new ASD diagnosis. He also sees, manages and helps parents whose children already have an established ASD diagnosis. The treatment plan always involves providing parents, older teens and young adults with resources and tools to help them address their weakness and build on their strengths. Sometimes, this includes medications. And it always involves shared decision making. Unlike most individuals who evaluate children for ASD, Dr. Moncino views ASD as chronic disorder that needs long-term, ongoing interaction with an ASD expert, not just an evaluation. As a physician, he views the assessment and diagnosis as the beginning of a long-term relationship between himself and the parents/child. ANXIETY / ADJUSTMENT DISORDERS AND DEPRESSION AND ADD/ADHD: Dr. Moncino assesses and treats children and teens with ADD/ADHD, anxiety disorders, adjustment disorders, depression and sleep disorders. While medications may play a role in the management of these problems, many times we can avoid or at least delay medications by using behavioral management techniques instead. SLEEP DISORDERS: Sleep difficulties in toddlers through the teenage years is an all-too-common problem in this day of 24/7/365 news cycles, electronic devices, gaming and social media. More than 25% of children with developmental concerns have nothing more than inadequate sleep. And in those children with ADD/ADHD, nearly half have sleep problems, while 75%-90% of children with ASD have sleep problems. These sleep difficulties can impact not just the child’s behavior and ability to learn, but their siblings’ sleep and ability to learn, as well as the entire family’s joy for life, the parents’ ability to function at work and the parents’ marriage. Dr. Moncino’s 40 years of clinical experience show that adequate sleep is the foundational treatment of all behavioral disorders in children and teens. Until adequate sleep has been addressed, no amount of therapy, medications or other behavioral interventions will be fully successful. In fact, once we address sleep issues, we find that behavior problems, such as explosive outbursts, inattention, distraction and even anxiety, resolve in more than one quarter of children. LEARNING DISORDER/DYSLEXIA Dr. Moncino’s role with learning disorders (LDs) is to help parents grasp their practical implications. He works with parents and the educational system to develop accommodations to help your child. If needed, he will address ADD/ADHD, anxiety disorders, sleep disorders and executive functioning disorders that often co-exist with LDs. While it’s the role of neuropsychologist, rather than Dr. Moncino, to do the typical battery of testing necessary to identify LDs, Dr. Moncino helps parents interpret evaluations and commit to a shared decision-making process to arrive at solutions to help their child. If a neuropsychological evaluation hasn’t been completed, Dr. Moncino can gather information about your child's learning profile, challenges in school, social issues and behaviors at home. Then, you and he will discuss whether your child would benefit from a formal evaluation. While LDs can’t be cured, there are many accommodations teachers can make to support your child’s weaknesses and foster great success throughout his/her education, including college (and, for Dr. Moncino, who has dyslexia, in medical school and beyond).

How long are appointments?

There’s too much variability to pin down an exact time, but that’s the beauty of working with Dr. Moncino…if you need more time, he’s right there with you. Here’s a guestimate of what you can expect: New patients:

• Intake sessions typically take 90 minutes. If your child has already been diagnosed with a developmental disorder, you might need a bit longer, up to two to three hours.

Do you accept any private insurance, Medicaid, or other third-party payers?

No. All services are fee-for-service (FFS), which means you’ll pay GCADP directly, but you can file for out-of-network (OON) benefits with your insurance company or Medicaid. Before each office or virtual visit appointment, you’ll know our fee based on the type and length of the appointment booked. Similarly, ASD evaluations (which can vary from 2-4 visits) are billed as a set global fee based on the age of the child, for the youngest children, if a home evaluation is requested, and for those over 4-years old, the volume of previous evaluations/records to review. Dr. Moncino will provide a statement you can submit to your insurance company, Health Savings Account or Employee Assistance Plan for reimbursement. For more detailed information about billing, and to review the GCADP Financial Policy (email us at billing_insurance_info@gcadp.com) Can’t find the answer here? Contact us at markmoncino@gcadp.com

What is involved in an evaluation?

It takes a careful and detailed medical, family and behavioral assessment to determine how best to help your child. Conducting a thorough evaluation takes time, especially with children and teens who don't necessarily understand an evaluation's value. Depending on the concerns, evaluations usually require between three and six visits over several days to a few weeks.

Some assessments result in formal diagnoses—such as ASD, ADD/ADHD or anxiety—that are best served by long-term relationships and care with GCADP. For other issues, once we address the challenging behaviors and give you the tools to manage your child's or teens' behaviors on your own, you may no longer need GCADP services. Still others—such as learning disabilities/disorders/dyslexia—result in follow up appointments every six to 12 to 24 months.

The goal of all assessments and care is to provide you with insights, tools and the guidance you need to help your child.

At GCADP, our approach to medications is conservative—a recommendation we make only if behavioral interventions aren't fully successful. And if your child does need medication, we'll discuss the long-term goal of helping him or her wean off the medication at some point in the future.

Does GCADP provide parent coaching and training?

Through 40 years of pediatric and adolescent medical care, Dr. Moncino has always put parent coaching—helping you manage your child's or teen's behavioral challenges—front and center. The evidence-based, individual guidance and instruction Dr. Moncino offers can go a long way toward helping you learn how to improve your child's behavior.

We encourage you to explore several of the existing evidence-based Behavioral Parent Training (BPT) resources on your own:

• "The Incredible Years"

• "Triple P"

• "Teen Triple P"

• "Parent-Child Interaction Therapy" (PCIT) trained therapists

• The CDC's "Parenting Toddlers and Preschoolers"

• "Everyday Parenting"

• "Smarter Parenting"

• "1-2-3 Magic"

If you need additional help GCADP is here to assist you.