Abstract
Background:
Pediatricians play a crucial role in the management of developmental and behavioral disorders in children. Understanding the factors influencing their satisfaction is essential for improving the quality of care. However, in Saudi Arabia, pediatricians’ satisfaction with their ability to manage developmental and behavioral disorders remains underexplored.
Objective:
To assess factors influencing pediatricians’ satisfaction when managing developmental and behavioral disorders in Saudi Arabia.
Methods:
A nationwide cross-sectional study was conducted between August 2021 and July 2022, using a validated questionnaire distributed electronically to all pediatricians registered with the Saudi Commission for Health Specialties. A total of 229 pediatricians participated in this study. Data on sociodemographic characteristics, clinical practice, training, and institutional support were collected and analyzed. Results: Satisfaction levels varied significantly according to nationality, training location, and years of experience. Saudi pediatricians, those trained locally, and those with more professional experience reported a higher satisfaction than others. Institutional support and clinical exposure were key factors that were positively associated with satisfaction.
Conclusion:
This study highlights the importance of clinical and institutional factors in shaping pediatricians’ satisfaction with the management of developmental and behavioral disorders. These findings suggest that targeted interventions focusing on training and support can enhance the developmental care of pediatricians in Saudi Arabia.
Keywords: Pediatricians, Developmental disorders, Children, Saudi Arabia, Healthcare
1. BACKGROUND
Developmental and behavioral pediatrics (DBP) has garnered increasing attention as a crucial component of pediatric care, often described as “the new morbidity” in modern pediatric practice, as first proposed by Haggerty (1). This subspecialty encompasses a wide range of conditions affecting children’s cognitive, emotional, social, and functional development, including autism spectrum disorders (ASDs), attention-deficit/hyperactivity disorders (ADHDs), learning disabilities, and intellectual disabilities.
Pediatricians serve as the first point of contact for children and their families, positioning them to identify developmental, psychosocial, and behavioral concerns early and to guide appropriate interventions (2, 3). Recent estimates indicate that the prevalence of developmental disabilities among school-aged children in the United States ranges from 12% to 17%, with trends showing a gradual increase over time (4). Factors such as insurance status and access to primary care may influence the recognition and management of these conditions, underscoring the need for systematic screening and timely referrals in pediatric practice (5). A 1999 study reported that 18.7% of children across the US, Canada, and Puerto Rico presented with behavioral issues (6). Another study using the Pediatric Symptom Checklist found a 13% and 10% prevalence of psychosocial problems in school-aged children and preschoolers, respectively (7). Together, these findings highlight the significant proportion of children affected by developmental and behavioral conditions and emphasize the critical role of pediatricians in early detection and intervention (2–7).
Parental expectations further reflect this shift in pediatric priorities. Approximately 70% of parents in pediatric waiting areas reported being more concerned about their child’s development, discipline, and behavioral issues than physical ailments (8). In Australia, such cases represent nearly one-third of the new referrals to private pediatric clinics (6, 9). Despite this growing demand, studies have shown that up to 83% of pediatricians fail to identify behavioral and emotional disorders in affected children (10).
A study conducted in Israel in 2007 found that only 53.4% of pediatricians were satisfied with their competence in managing children with developmental and behavioral issues. Satisfaction was associated with access to child development services, training in developmental pediatrics, and regular psychiatric updates (11). However, several studies have indicated persistent knowledge and confidence gaps. For example, a 2015 study revealed that 91.1% of pediatricians felt unqualified to diagnose autism based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (12), while a 2021 study from Turkey found that although general knowledge of ASD symptoms was acceptable, knowledge about its etiology and comorbidities was significantly lacking (13).
Moreover, an Indonesian study found that most pediatricians had poor knowledge, perceptions, and attitudes toward ADHD, with no significant correlation between years of experience and knowledge levels (14). Similarly, a qualitative study from Saudi Arabia (2022) reported that many general pediatricians in public clinics experienced low confidence when handling behavioral and developmental cases, attributing this to limited training during residency and delayed access to referral services (15).
A 2024 study in the UAE showed that only one-third of primary care physicians had received formal training in child psychiatry and more than half felt unprepared to manage such conditions, citing systemic barriers such as limited access to referrals and inadequate collaborative care frameworks (16). These findings mirror global trends, highlighting a disconnection between the increasing burden of developmental disorders and preparedness of primary pediatric care providers.
Early identification and timely intervention are critical. When appropriately addressed, some developmental conditions may be treated definitively, whereas others can be better managed to improve long-term outcomes for children and their families (17). However, in Saudi Arabia, pediatricians’ satisfaction with their ability to manage developmental and behavioral disorders (DBDs) remains underexplored.
2. OBJECTIVE
This study aimed to assess the level of satisfaction among pediatricians in Saudi Arabia regarding their professional ability to manage developmental, behavioral, and psychosocial disorders and to identify the personal, clinical, and institutional factors influencing this satisfaction.
3. MATERIAL AND METHODS
Study Design and Setting
This national, cross-sectional study used a questionnaire-based survey. The study targeted pediatricians practicing in the Kingdom of Saudi Arabia across various healthcare sectors. The data were collected between August 2021 and July 2022. The survey was disseminated via the Saudi Commission for Health Specialties (SCFHS) to pediatricians registered with the commission, including residents, specialists, and consultants.
Study Participants
The study population included all pediatricians affiliated with the SCFHS, including trainees (residents), specialists, and consultants. Pediatricians who were not affiliated with the SCFHS and those who did not complete the questionnaire were excluded. According to the SCFHS records, there were 1,472 pediatricians practicing in Saudi Arabia at the time of the study. A total of 229 pediatricians completed the survey, yielding a response rate of approximately 16%.
Data Collection Tool and Process
Data were collected using a previously validated English-language questionnaire originally developed by Senecky et al (11), which was used with permission. Minor modifications were made to adapt the instrument to the local educational and healthcare contexts. The questionnaire comprised four main sections.
Section A: Personal characteristics, including age, sex, marital status, nationality, academic degree, country of medical school graduation, residency training location, and current subspecialty (if any).
Section B: Practice characteristics such as years of practice; weekly working hours; average number of patients seen daily; number of ADHD, ASD, and developmental delay cases under current care; referral patterns; and prescribing practices.
Section C: Experience with developmental, behavioral, and psychosocial disorders, consisting of 11 questions assessing clinical exposure and familiarity.
Section D: Satisfaction with professional ability, containing 11 items evaluating pediatricians’ self-perceived satisfaction with managing DBDs.
The questionnaire was distributed electronically through the SCFHS system, and participation was voluntary. All responses were anonymized.
Statistical Analysis
The data were cleaned and analyzed using STATA version 16 (StataCorp LLC, College Station, TX, USA). Descriptive statistics were used to summarize categorical variables (frequencies and percentages) and continuous variables (mean [standard deviation] and median [range]). Inferential statistics were applied to explore the associations between independent variables and satisfaction levels. The Chi-square and Fisher’s exact tests were used for categorical comparisons. Independent t-test and analysis of variance were used for continuous variables, and a univariate logistic regression analysis was performed to identify predictors of high satisfaction. Statistical significance was set at p < 0.05.
Ethical Considerations
This study was approved by the Institutional Review Board (IRB-2021-01-287) on August 29, 2021, through an expedited review process. The study followed the “Guidelines for Ethical Research Practice” and complied with the principles of the Declaration of Helsinki. Participation was voluntary, and informed consent was obtained by completing an anonymous questionnaire. No identifiable personal data were obtained.
4. RESULTS
The study included 229 pediatricians. Their personal characteristics are shown in Table 1. The participants had a mean age of 41 years (standard deviation = 12). The characteristics reflect a diverse, yet predominantly locally trained, pediatric workforce.
Table 1. Personal Characteristics of Study Population.
| Variables | Count | Percentage % | |
|---|---|---|---|
| Sex | Male | 109 | 47.6% |
| Female | 120 | 52.4% | |
| Marital status | Single | 49 | 21.4% |
| Married | 176 | 76.9% | |
| Divorced | 3 | 1.3% | |
| Widow | 1 | 0.4% | |
| Nationality | Non-Saudi | 84 | 36.7% |
| Saudi | 145 | 63.3% | |
| Current academic degree | Resident/ Trainee | 65 | 28.4% |
| Senior registrar/Specialist/Fellow | 88 | 38.4% | |
| Consultant | 76 | 33.2% | |
| Country of medical school graduated from | Saudi Arabia | 138 | 60.3% |
| Abroad | 91 | 39.7% | |
| Country of pediatric residency training | Saudi Arabia | 154 | 67.2% |
| Abroad | 75 | 32.8% | |
Table 2 summarizes clinical practice patterns and exposure to DBDs. The mean number of working hours per week was 52. Although more than half of the participants reported no children with ADHD or ASD under their care, 74.7% were managing at least one child with a developmental delay.
Table 2. Practice Characteristics of Study Population.
| Variable | Count | Percentage % | |
|---|---|---|---|
| Practice years in the field of Pediatrics | 1-2 | 46 | 20.1% |
| 3-4 | 20 | 8.7% | |
| 5-6 | 27 | 11.8% | |
| 7-8 | 11 | 4.8% | |
| 8-9 | 14 | 6.1% | |
| > 10 | 111 | 48.5% | |
| Number of total patients seen per day | 1-5 | 39 | 17.0% |
| 6-10 | 81 | 35.4% | |
| 11-15 | 43 | 18.8% | |
| > 15 | 66 | 28.8% | |
| Number of children with attention deficit/hyperactivity disorder (ADHD) under current care | None | 123 | 53.7% |
| 1-5 | 80 | 34.9% | |
| 6-10 | 18 | 7.9% | |
| 11-20 | 2 | 0.9% | |
| > 20 | 6 | 2.6% | |
| Percentage of ADHD cases referred for additional counseling in the past | None | 51 | 22.3% |
| 1-20% | 149 | 65.1% | |
| 21-40% | 15 | 6.6% | |
| 41-60% | 2 | 0.9% | |
| > 60% | 12 | 5.2% | |
| Have you prescribed any ADHD medications in the past ? | No | 189 | 82.5% |
| Yes | 40 | 17.5% | |
| Number of children with autism spectrum disorder (ASD) under current care | None | 119 | 52.0% |
| 1-5 | 81 | 35.4% | |
| 6-10 | 18 | 7.9% | |
| 11-20 | 7 | 3.1% | |
| > 20 | 4 | 1.7% | |
| Percentage of ASD cases referred for additional counseling in the past | None | 65 | 28.4% |
| 1-20% | 136 | 59.4% | |
| 21-40% | 13 | 5.7% | |
| 41-60% | 3 | 1.3% | |
| > 60% | 12 | 5.2% | |
| Have you prescribed any ASD medications in the past? | No | 199 | 86.9% |
| Yes | 30 | 13.1% | |
| Number of children with developmental delay children under current care | None | 58 | 25.3% |
| 1-5 | 103 | 45.0% | |
| 6-10 | 27 | 11.8% | |
| 11-20 | 14 | 6.1% | |
| > 20 Patients | 27 | 11.8% | |
| Percentage of developmental delay cases referred for additional counseling in the past: | None | 26 | 11.4% |
| 1-20% | 110 | 48.0% | |
| 21-40% | 54 | 23.6% | |
| 41-60% | 15 | 6.6% | |
| > 60% | 24 | 10.5% | |
| Satisfaction with overall personal professional ability in child development field | None | 20 | 8.7% |
| Slight | 98 | 42.8% | |
| Moderate | 95 | 41.5% | |
| High | 16 | 7.0% | |
Most pediatricians referred 1-20% of their patients with ADHD, ASD, or developmental delay for further counseling. These results suggest limited direct involvement in pharmacological and counseling interventions for DBDs in a substantial proportion of the participants.
The associations between satisfaction and personal characteristics are presented in Table 3. Several factors were significantly correlated with higher levels of satisfaction with managing developmental and behavioral conditions. Married pediatricians reported significantly greater satisfaction than their single counterparts (p = 0.004). Saudi nationals were more likely to be satisfied with their professional abilities than non-Saudi nationals (p = 0.005). Educational background also played a role; pediatricians who graduated from Saudi medical schools (p = 0.006) and those who completed residency in Saudi Arabia (p = 0.010) reported higher satisfaction levels. Satisfaction increases with seniority. Consultants reported significantly higher satisfaction than residents and specialists (p < 0.001). Additionally, subspecialty was significantly associated with satisfaction (p = 0.001). Pediatricians in nephrology, neonatology, intensive care, infectious diseases, and genetics/metabolism tended to report higher confidence in dealing with developmental and behavioral cases.
Table 3. Correlation Between Personal Characteristics and Satisfaction. CS, current subspecialty.
| Variable | Satisfaction with overall personal professional ability in child development field | |||||
|---|---|---|---|---|---|---|
| None, n (%) | Slight, n (%) | Moderate, n (%) | High, n (%) | p-value | ||
| Sex | Male | 9 (45.0) | 49 (50.0) | 45 (47.4) | 6 (37.5) | 0.817 |
| Female | 11 (55.0) | 49 (50.0) | 50 (52.6) | 10 (62.5) | ||
| Marital status | Single | 6 (30.0) | 27 (27.6) | 16 (16.8) | 0 (0.0) | 0.004 |
| Married | 14 (70.0) | 70 (71.4) | 78 (82.1) | 14 (87.5) | ||
| Divorced | 0 (0.0) | 1 (1.0) | 1 (1.1) | 1 (6.3) | ||
| Widow | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (6.3) | ||
| Nationality | Non-Saudi | 3 (15.0) | 28 (28.6) | 46 (48.4) | 7 (43.8) | 0.005 |
| Saudi | 17 (85.0) | 70 (71.4) | 49 (51.6) | 9 (56.3) | ||
| Current academic degree | Resident/Trainee | 8 (40.0) | 36 (36.7) | 21 (22.1) | 0 (0.0) | < 0.001 |
| Senior registrar/Specialist/Fellow | 1 (5.0) | 35 (35.7) | 46 (48.4) | 6 (37.5) | ||
| Consultant | 11 (55.0) | 27 (27.6) | 28 (29.5) | 10 (62.5) | ||
| Country of medical school graduated from | Saudi Arabia | 17 (85.0) | 66 (67.3) | 47 (49.5) | 8 (50.0) | 0.006 |
| Abroad | 3 (15.0) | 32 (32.7) | 48 (50.5) | 8 (50.0) | ||
| Country of pediatric residency training | Saudi Arabia | 18 (90.0) | 72 (73.5) | 54 (56.8) | 10 (62.5) | 0.010 |
| Abroad | 2 (10.0) | 26 (26.5) | 41 (43.2) | 6 (37.5) | ||
| Specialty | ||||||
| CS=General pediatrics | No | 9 (45.0) | 18 (18.4) | 22 (23.2) | 4 (25.0) | 0.084 |
| Yes | 11 (55.0) | 80 (81.6) | 73 (76.8) | 12 (75.0) | ||
| CS=Pediatric neurology | No | 20 (100.0) | 96 (98.0) | 92 (96.8) | 14 (87.5) | 0.122 |
| Yes | 0 (0.0) | 2 (2.0) | 3 (3.2) | 2 (12.5) | ||
| CS=Pediatric emergency medicine | No | 19 (95.0) | 92 (93.9) | 88 (92.6) | 16 (100.0) | 0.718 |
| Yes | 1 (5.0) | 6 (6.1) | 7 (7.4) | 0 (0.0) | ||
| CS=Pediatric nephrology | No | 18 (90.0) | 98 (100.0) | 94 (98.9) | 16 (100.0) | 0.004 |
| Yes | 2 (10.0) | 0 (0.0) | 1 (1.1) | 0 (0.0) | ||
| CS=Pediatric rheumatology | No | 20 (100.0) | 97 (99.0) | 95 (100.0) | 16 (100.0) | 0.719 |
| Yes | 0 (0.0) | 1 (1.0) | 0 (0.0) | 0 (0.0) | ||
| CS=Pediatric hematology/oncology | No | 19 (95.0) | 96 (98.0) | 95 (100.0) | 16 (100.0) | 0.263 |
| Yes | 1 (5.0) | 2 (2.0) | 0 (0.0) | 0 (0.0) | ||
| CS=Pediatric allergy/immunology | No | 20 (100.0) | 98 (100.0) | 94 (98.9) | 15 (93.8) | 0.093 |
| Yes | 0 (0.0) | 0 (0.0) | 1 (1.1) | 1 (6.3) | ||
| CS=Pediatric gastroenterology | No | 20 (100.0) | 97 (99.0) | 95 (100.0) | 16 (100.0) | 0.719 |
| Yes | 0 (0.0) | 1 (1.0) | 0 (0.0) | 0 (0.0) | ||
| CS=Cardiology | No | 18 (90.0) | 95 (96.9) | 89 (93.7) | 16 (100.0) | 0.374 |
| Yes | 2 (10.0) | 3 (3.1) | 6 (6.3) | 0 (0.0) | ||
| CS=Pediatric endocrinology | No | 18 (90.0) | 97 (99.0) | 90 (94.7) | 16 (100.0) | 0.124 |
| Yes | 2 (10.0) | 1 (1.0) | 5 (5.3) | 0 (0.0) | ||
| CS=Pediatric infectious disease | No | 18 (90.0) | 98 (100.0) | 92 (96.8) | 16 (100.0) | 0.034 |
| Yes | 2 (10.0) | 0 (0.0) | 3 (3.2) | 0 (0.0) | ||
| CS=Pediatric intensive care medicine | No | 20 (100.0) | 96 (98.0) | 84 (88.4) | 15 (93.8) | 0.028 |
| Yes | 0 (0.0) | 2 (2.0) | 11 (11.6) | 1 (6.3) | ||
| CS=Neonatology | No | 19 (95.0) | 96 (98.0) | 83 (87.4) | 16 (100.0) | 0.017 |
| Yes | 1 (5.0) | 2 (2.0) | 12 (12.6) | 0 (0.0) | ||
| CS=Metabolic/Genetics | No | 20 (100.0) | 98 (100.0) | 95 (100.0) | 15 (93.8) | 0.004 |
| Yes | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (6.3) | ||
| CS= pulmonology | No | 20 (100.0) | 98 (100.0) | 95 (100.0) | 15 (93.8) | 0.004 |
| Yes | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (6.3) | ||
As shown in Table 4, several aspects of clinical practice were significantly associated with patient satisfaction. Pediatricians with > 10 years of experience were more likely to report higher levels of satisfaction (p = 0.001). Greater exposure to DBDs was also positively correlated; managing more ADHD, ASD, and developmental delay cases was significantly associated with higher satisfaction (all p < 0.001). Furthermore, pediatricians who prescribed medications for ADHD demonstrated higher satisfaction levels (p = 0.002), whereas prescribing ASD medications was not significantly associated with satisfaction (p = 0.628). Referral behavior was another significant factor; pediatricians who referred more patients for counseling, particularly those with ADHD (p = 0.001) and developmental delays (p = 0.003), tended to report greater professional satisfaction.
Table 4. Correlation Between Practice Characteristics and Satisfaction.
| Variable | Satisfaction with overall personal professional ability in child development field | |||||
|---|---|---|---|---|---|---|
| None, n (%) | Slight, n (%) | Moderate, n (%) | High, n (%) | p-value | ||
| Practice years in the field of Pediatrics | 1-2 | 4 (20.0) | 27 (27.6) | 15 (15.8) | 0 (0.0) | 0.001 |
| 3-4 | 3 (15.0) | 11 (11.2) | 5 (5.3) | 1 (6.3) | ||
| 5-6 | 1 (5.0) | 12 (12.2) | 10 (10.5) | 4 (25.0) | ||
| 7-8 | 0 (0.0) | 10 (10.2) | 1 (1.1) | 0 (0.0) | ||
| 8-9 | 0 (0.0) | 8 (8.2) | 6 (6.3) | 0 (0.0) | ||
| > 10 | 12 (60.0) | 30 (30.6) | 58 (61.1) | 11 (68.8) | ||
| Number of total patients seen per day | 1-5 | 7 (35.0) | 15 (15.3) | 16 (16.8) | 1 (6.3) | 0.126 |
| 6-10 | 7 (35.0) | 38 (38.8) | 31 (32.6) | 5 (31.3) | ||
| 11-15 | 3 (15.0) | 21 (21.4) | 18 (18.9) | 1 (6.3) | ||
| > 15 | 3 (15.0) | 24 (24.5) | 30 (31.6) | 9 (56.3) | ||
| Number of children with attention deficit/hyperactivity disorder (ADHD) under current care | None | 15 (75.0) | 66 (67.3) | 39 (41.1) | 3 (18.8) | < 0.001 |
| 1-5 | 3 (15.0) | 30 (30.6) | 41 (43.2) | 6 (37.5) | ||
| 6-10 | 2 (10.0) | 1 (1.0) | 11 (11.6) | 4 (25.0) | ||
| 11-20 | 0 (0.0) | 0 (0.0) | 1 (1.1) | 1 (6.3) | ||
| > 20 | 0 (0.0) | 1 (1.0) | 3 (3.2) | 2 (12.5) | ||
| Percentage of ADHD cases referred for additional counseling in the past | None | 10 (50.0) | 24 (24.5) | 16 (16.8) | 1 (6.3) | 0.001 |
| 1-20% | 8 (40.0) | 68 (69.4) | 64 (67.4) | 9 (56.3) | ||
| 21-40% | 1 (5.0) | 2 (2.0) | 7 (7.4) | 5 (31.3) | ||
| 41-60% | 0 (0.0) | 0 (0.0) | 2 (2.1) | 0 (0.0) | ||
| > 60% | 1 (5.0) | 4 (4.1) | 6 (6.3) | 1 (6.3) | ||
| Have you prescribed any ADHD medications in the past? | No | 20 (100.0) | 86 (87.8) | 74 (77.9) | 9 (56.3) | 0.002 |
| Yes | 0 (0.0) | 12 (12.2) | 21 (22.1) | 7 (43.8) | ||
| Number of children with autism spectrum disorder (ASD) under current care | None | 17 (85.0) | 59 (60.2) | 41 (43.2) | 2 (12.5) | < 0.001 |
| 1-5 | 1 (5.0) | 36 (36.7) | 35 (36.8) | 9 (56.3) | ||
| 6-10 | 2 (10.0) | 2 (2.0) | 13 (13.7) | 1 (6.3) | ||
| 11-20 | 0 (0.0) | 0 (0.0) | 3 (3.2) | 4 (25.0) | ||
| > 20 | 0 (0.0) | 1 (1.0) | 3 (3.2) | 0 (0.0) | ||
| Percentage of ASD cases referred for additional counseling in the past | None | 12 (60.0) | 30 (30.6) | 21 (22.1) | 2 (12.5) | 0.001 |
| 1-20% | 7 (35.0) | 63 (64.3) | 57 (60.0) | 9 (56.3) | ||
| 21-40% | 0 (0.0) | 1 (1.0) | 8 (8.4) | 4 (25.0) | ||
| 41- 60% | 0 (0.0) | 1 (1.0) | 2 (2.1) | 0 (0.0) | ||
| > 60% | 1 (5.0) | 3 (3.1) | 7 (7.4) | 1 (6.3) | ||
| Have you prescribed any ASD medications in the past? | No | 19 (95.0) | 84 (85.7) | 83 (87.4) | 13 (81.3) | 0.628 |
| Yes | 1 (5.0) | 14 (14.3) | 12 (12.6) | 3 (18.8) | ||
| Number of children with developmental delay children under current care | None | 11 (55.0) | 27 (27.6) | 19 (20.0) | 1 (6.3) | < 0.001 |
| 1-5 | 4 (20.0) | 47 (48.0) | 48 (50.5) | 4 (25.0) | ||
| 6-10 | 1 (5.0) | 13 (13.3) | 11 (11.6) | 2 (12.5) | ||
| 11-20 | 0 (0.0) | 5 (5.1) | 6 (6.3) | 3 (18.8) | ||
| > 20 | 4 (20.0) | 6 (6.1) | 11 (11.6) | 6 (37.5) | ||
| Percentage of developmental delay cases referred for additional counseling in the past | None | 8 (40.0) | 8 (8.2) | 9 (9.5) | 1 (6.3) | 0.003 |
| 1-20% | 4 (20.0) | 51 (52.0) | 49 (51.6) | 6 (37.5) | ||
| 21-40% | 5 (25.0) | 25 (25.5) | 20 (21.1) | 4 (25.0) | ||
| 41-60% | 1 (5.0) | 7 (7.1) | 7 (7.4) | 0 (0.0) | ||
| > 60% | 2 (10.0) | 7 (7.1) | 10 (10.5) | 5 (31.3) | ||
The results presented in Table 5 demonstrate that training and institutional support are strongly associated with satisfaction. Moderate or high levels of training in child development during residency was a significant predictor of satisfaction (p < 0.001). Additionally, receiving regular updates at the workplace for both child development (p < 0.001) and psychiatry (p = 0.012) was associated with higher satisfaction. The availability of diagnostic and therapeutic services for child development and psychiatry at pediatric institutions was also significantly associated with increased satisfaction (p = 0.014 and 0.001, respectively). Furthermore, receiving feedback from referral centers, whether in child development or psychiatry, showed strong positive associations (both p < 0.001), suggesting that collaborative care models meaningfully contribute to professional confidence.
Table 5. Correlation Between Training or Institutional Support and Satisfaction.
| Variable | Satisfaction with overall personal professional ability in child development field | |||||
|---|---|---|---|---|---|---|
| None, n (%) | Slight, n (%) | Moderate, n (%) | High, n (%) | p-value | ||
| Training received in child development during residency program | None | 9 (45.0) | 13 (13.3) | 12 (12.6) | 0 (0.0) | <0.001 |
| Slight | 6 (30.0) | 54 (55.1) | 28 (29.5) | 1 (6.3) | ||
| Moderate | 5 (25.0) | 25 (25.5) | 37 (38.9) | 11 (68.8) | ||
| High | 0 (0.0) | 6 (6.1) | 15 (15.8) | 4 (25.0) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 3 (3.2) | 0 (0.0) | ||
| Updates given at the workplace in child development | None | 10 (50.0) | 31 (31.6) | 13 (13.7) | 1 (6.3) | 0.003 |
| Slight | 4 (20.0) | 47 (48.0) | 34 (35.8) | 5 (31.3) | ||
| Moderate | 6 (30.0) | 16 (16.3) | 36 (37.9) | 4 (25.0) | ||
| High | 0 (0.0) | 3 (3.1) | 10 (10.5) | 6 (37.5) | ||
| Not applicable | 0 (0.0) | 1 (1.0) | 2 (2.1) | 0 (0.0) | ||
| Availability of child development diagnostic services at your workplace | None | 11 (55.0) | 21 (21.4) | 10 (10.5) | 1 (6.3) | 0.014 |
| Slight | 4 (20.0) | 32 (32.7) | 27 (28.4) | 6 (37.5) | ||
| Moderate | 5 (25.0) | 31 (31.6) | 37 (38.9) | 6 (37.5) | ||
| High | 0 (0.0) | 10 (10.2) | 19 (20.0) | 3 (18.8) | ||
| Not applicable | 0 (0.0) | 4 (4.1) | 2 (2.1) | 0 (0.0) | ||
| Availability of child development therapeutic services at your workplace | None | 10 (50.0) | 25 (25.5) | 14 (14.7) | 1 (6.3) | 0.001 |
| Slight | 6 (30.0) | 36 (36.7) | 29 (30.5) | 6 (37.5) | ||
| Moderate | 1 (5.0) | 23 (23.5) | 36 (37.9) | 6 (37.5) | ||
| High | 3 (15.0) | 11 (11.2) | 14 (14.7) | 3 (18.8) | ||
| Not applicable | 0 (0.0) | 3 (3.1) | 2 (2.1) | 0 (0.0) | ||
| Training received in child psychiatry | None | 17 (85.0) | 58 (59.2) | 42 (44.2) | 3 (18.8) | 0.027 |
| Slight | 2 (10.0) | 33 (33.7) | 27 (28.4) | 10 (62.5) | ||
| Moderate | 1 (5.0) | 4 (4.1) | 22 (23.2) | 2 (12.5) | ||
| High | 0 (0.0) | 2 (2.0) | 2 (2.1) | 1 (6.3) | ||
| Not applicable | 0 (0.0) | 1 (1.0) | 2 (2.1) | 0 (0.0) | ||
| Updates given at the workplace in child psychiatry | None | 15 (75.0) | 64 (65.3) | 45 (47.4) | 6 (37.5) | 0.094 |
| Slight | 5 (25.0) | 23 (23.5) | 28 (29.5) | 3 (18.8) | ||
| Moderate | 0 (0.0) | 6 (6.1) | 19 (20.0) | 6 (37.5) | ||
| High | 0 (0.0) | 3 (3.1) | 1 (1.1) | 1 (6.3) | ||
| Not applicable | 0 (0.0) | 2 (2.0) | 2 (2.1) | 0 (0.0) | ||
| Availability of child psychiatry services at your workplace | None | 9 (45.0) | 39 (39.8) | 26 (27.4) | 4 (25.0) | 0.018 |
| Slight | 3 (15.0) | 35 (35.7) | 32 (33.7) | 1 (6.3) | ||
| Moderate | 4 (20.0) | 9 (9.2) | 26 (27.4) | 11 (68.8) | ||
| High | 4 (20.0) | 14 (14.3) | 10 (10.5) | 0 (0.0) | ||
| Not applicable | 0 (0.0) | 1 (1.0) | 1 (1.1) | 0 (0.0) | ||
| Replies received from child development centers (in case of referring a child in need) | None | 15 (75.0) | 45 (45.9) | 24 (25.3) | 0 (0.0) | < 0.001 |
| Slight | 1 (5.0) | 22 (22.4) | 27 (28.4) | 5 (31.3) | ||
| Moderate | 2 (10.0) | 10 (10.2) | 30 (31.6) | 8 (50.0) | ||
| High | 0 (0.0) | 9 (9.2) | 9 (9.5) | 3 (18.8) | ||
| Not applicable | 2 (10.0) | 12 (12.2) | 5 (5.3) | 0 (0.0) | ||
| Replies received from child psychiatry services (in case of referring a child in need) | None | 9 (45.0) | 37 (37.8) | 21 (22.1) | 1 (6.3) | < 0.001 |
| Slight | 6 (30.0) | 32 (32.7) | 24 (25.3) | 4 (25.0) | ||
| Moderate | 2 (10.0) | 9 (9.2) | 37 (38.9) | 9 (56.3) | ||
| High | 0 (0.0) | 9 (9.2) | 10 (10.5) | 2 (12.5) | ||
| Not applicable | 3 (15.0) | 11 (11.2) | 3 (3.2) | 0 (0.0) | ||
| Child development services in general at your workplace | None | 8 (40.0) | 30 (30.6) | 18 (18.9) | 1 (6.3) | 0.074 |
| Slight | 6 (30.0) | 41 (41.8) | 27 (28.4) | 4 (25.0) | ||
| Moderate | 6 (30.0) | 16 (16.3) | 37 (38.9) | 10 (62.5) | ||
| High | 0 (0.0) | 10 (10.2) | 12 (12.6) | 1 (6.3) | ||
| Not applicable | 0 (0.0) | 1 (1.0) | 1 (1.1) | 0 (0.0) | ||
| Child psychiatry services in general at your workplace | None | 6 (30.0) | 32 (32.7) | 23 (24.2) | 3 (18.8) | 0.046 |
| Slight | 9 (45.0) | 42 (42.9) | 32 (33.7) | 3 (18.8) | ||
| Moderate | 2 (10.0) | 12 (12.2) | 33 (34.7) | 6 (37.5) | ||
| High | 3 (15.0) | 10 (10.2) | 7 (7.4) | 4 (25.0) | ||
| Not applicable | 0 (0.0) | 2 (2.0) | 0 (0.0) | 0 (0.0) | ||
Further analysis (Table 6) revealed that pediatricians who reported satisfaction with institutional elements such as training, service availability, and referral communication were significantly more likely to express overall satisfaction with their ability to manage DBDs.
Table 6. Correlation Between Satisfaction with Institutional Elements and Overall Satisfaction.
| Variable | Satisfaction with overall personal professional ability in child development field | |||||
|---|---|---|---|---|---|---|
| None, n (%) | Slight, n (%) | Moderate, n (%) | High, n (%) | p-value | ||
| How satisfied are you with your training in child development? | None | 12 (60.0) | 21 (21.4) | 13 (13.7) | 2 (12.5) | < 0.001 |
| Slight | 6 (30.0) | 48 (49.0) | 24 (25.3) | 4 (25.0) | ||
| Moderate | 1 (5.0) | 23 (23.5) | 38 (40.0) | 5 (31.3) | ||
| High | 1 (5.0) | 6 (6.1) | 20 (21.1) | 5 (31.3) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with updates given in child development at your workplace? | None | 12 (60.0) | 29 (29.6) | 21 (22.1) | 4 (25.0) | 0.003 |
| Slight | 7 (35.0) | 43 (43.9) | 29 (30.5) | 4 (25.0) | ||
| Moderate | 0 (0.0) | 19 (19.4) | 34 (35.8) | 5 (31.3) | ||
| High | 1 (5.0) | 7 (7.1) | 11 (11.6) | 3 (18.8) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with the child development diagnostic services at your workplace? | None | 9 (45.0) | 29 (29.6) | 25 (26.3) | 4 (25.0) | 0.014 |
| Slight | 5 (25.0) | 42 (42.9) | 26 (27.4) | 1 (6.3) | ||
| Moderate | 5 (25.0) | 15 (15.3) | 27 (28.4) | 8 (50.0) | ||
| High | 1 (5.0) | 12 (12.2) | 17 (17.9) | 3 (18.8) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with the child development therapeutic services at your workplace? | None | 8 (40.0) | 31 (31.6) | 20 (21.1) | 3 (18.8) | 0.001 |
| Slight | 4 (20.0) | 48 (49.0) | 27 (28.4) | 4 (25.0) | ||
| Moderate | 7 (35.0) | 15 (15.3) | 31 (32.6) | 7 (43.8) | ||
| High | 1 (5.0) | 4 (4.1) | 17 (17.9) | 2 (12.5) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with your training in child psychiatry? | None | 12 (60.0) | 44 (44.9) | 33 (34.7) | 4 (25.0) | 0.027 |
| Slight | 6 (30.0) | 39 (39.8) | 28 (29.5) | 6 (37.5) | ||
| Moderate | 1 (5.0) | 10 (10.2) | 25 (26.3) | 3 (18.8) | ||
| High | 1 (5.0) | 5 (5.1) | 9 (9.5) | 3 (18.8) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with updates given in child psychiatry at your workplace? | None | 9 (45.0) | 46 (46.9) | 29 (30.5) | 4 (25.0) | 0.094 |
| Slight | 7 (35.0) | 36 (36.7) | 31 (32.6) | 7 (43.8) | ||
| Moderate | 3 (15.0) | 14 (14.3) | 27 (28.4) | 3 (18.8) | ||
| High | 1 (5.0) | 2 (2.0) | 8 (8.4) | 2 (12.5) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with the available psychiatry services at your workplace? | None | 9 (45.0) | 42 (42.9) | 24 (25.3) | 4 (25.0) | 0.018 |
| Slight | 5 (25.0) | 32 (32.7) | 29 (30.5) | 1 (6.3) | ||
| Moderate | 4 (20.0) | 17 (17.3) | 31 (32.6) | 9 (56.3) | ||
| High | 2 (10.0) | 7 (7.1) | 11 (11.6) | 2 (12.5) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with the replies received from child development centers? | None | 13 (65.0) | 36 (36.7) | 20 (21.1) | 2 (12.5) | < 0.001 |
| Slight | 5 (25.0) | 44 (44.9) | 37 (38.9) | 3 (18.8) | ||
| Moderate | 1 (5.0) | 15 (15.3) | 23 (24.2) | 10 (62.5) | ||
| High | 1 (5.0) | 3 (3.1) | 15 (15.8) | 1 (6.3) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with the replies received from child psychiatry services? | None | 12 (60.0) | 44 (44.9) | 19 (20.0) | 3 (18.8) | < 0.001 |
| Slight | 3 (15.0) | 37 (37.8) | 32 (33.7) | 0 (0.0) | ||
| Moderate | 3 (15.0) | 10 (10.2) | 36 (37.9) | 12 (75.0) | ||
| High | 2 (10.0) | 7 (7.1) | 8 (8.4) | 1 (6.3) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with child development services in general at your workplace? | None | 9 (45.0) | 32 (32.7) | 23 (24.2) | 3 (18.8) | 0.074 |
| Slight | 4 (20.0) | 42 (42.9) | 30 (31.6) | 6 (37.5) | ||
| Moderate | 6 (30.0) | 19 (19.4) | 26 (27.4) | 5 (31.3) | ||
| High | 1 (5.0) | 5 (5.1) | 16 (16.8) | 2 (12.5) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| How satisfied are you with child psychiatry services in general at your workplace? | None | 8 (40.0) | 34 (34.7) | 24 (25.3) | 3 (18.8) | 0.046 |
| Slight | 4 (20.0) | 34 (34.7) | 26 (27.4) | 3 (18.8) | ||
| Moderate | 6 (30.0) | 18 (18.4) | 39 (41.1) | 7 (43.8) | ||
| High | 2 (10.0) | 12 (12.2) | 6 (6.3) | 3 (18.8) | ||
| Not applicable | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Specifically, satisfaction with training in child development (p < 0.001), availability of diagnostic and therapeutic services (p = 0.014 and 0.001, respectively), and feedback from referral services (p < 0.001) were independently associated with higher levels of perceived competence. These findings emphasize the impact of workplace infrastructure and support systems on pediatricians’ professional satisfaction.
5. DISCUSSION
This study assessed pediatricians’ professional satisfaction with managing DBDs in Saudi Arabia, highlighting the multiple individual and institutional factors associated with confidence and competence in this domain. Despite the rising prevalence of DBDs and increasing parental concern in the region, the findings revealed a generally low level of satisfaction among pediatricians, with only a small proportion reporting high confidence in managing these cases.
The limited satisfaction observed aligns with earlier regional studies that have consistently pointed to insufficient training and underdeveloped service systems as key barriers to quality developmental care (18,19). For example, initiatives to build capacity for community pediatric autism diagnosis have shown that structured training programs for primary care clinicians improve diagnostic efficiency and access to care, reflecting systemic improvements in managing developmental disorders (20). This reinforces the notion that the challenge is systemic rather than individual.
Tables 3 and 4 show that satisfaction was significantly associated with seniority, clinical experience, and active engagement in managing developmental cases. Consultants and those with > 10 years of experience reported significantly higher satisfaction, suggesting that comfort with DBDs develops over time and with repeated clinical exposure. This trend is consistent with research showing that diagnostic accuracy among trained primary care clinicians is significantly higher, and that general pediatricians’ diagnostic decisions often align closely with those of specialists—underscoring the role of experience and repeated exposure in building confidence (21).
Interestingly, pediatricians who reported prescribing ADHD medication or referring more patients for counseling were also more satisfied, likely reflecting their increased familiarity and confidence. However, despite this, the overall rates of prescription and referral remained low; only 17.5% had prescribed ADHD medications, and more than half had never prescribed any treatment for ASD. These findings highlight the ongoing hesitancy or uncertainty in the pharmacological management of DBDs among pediatricians, possibly owing to a lack of training or institutional support.
Institutional and educational factors have a profound effect on satisfaction. As illustrated in Tables 5 and 6, pediatricians who received moderate or high training during their residency and those who had access to diagnostic, therapeutic, and psychiatric services reported significantly greater satisfaction. Regular updates and structured feedback from referral centers are also critical. These findings are consistent with those of Senecky et al, who reported that Israeli pediatricians receiving institutional feedback and support felt more capable of handling developmental cases (11).
Another important point is the role of inter-professional collaboration. Our results showed that the presence of feedback from referral services (eg, child development centers and psychiatry department) was strongly associated with increased satisfaction. This finding underscores the importance of a responsive and communicative referral system that improves both provider confidence and patient outcomes (22).
The relatively low level of satisfaction found in this study may also be associated with the lack of integration of DBP into core pediatric curricula and clinical exposure in residency programs across Saudi Arabia. Despite the lack of formal preparation in this area, many pediatricians are expected to manage complex developmental disorders. As Hix-Small et al argued, even briefly focused training modules can significantly enhance pediatricians’ developmental screening practices and comfort (23).
Given that professional satisfaction is associated with care quality, burnout prevention, and job retention, the results of this study have substantial implications for health-system development. Investment in structured training during residency, continuing education, and the expansion of child development services across regions may not only improve pediatricians’ satisfaction, but also enhance early identification and management of developmental delays in children.
These findings should inform national policy discussions on child health services, particularly regarding workforce planning and curriculum design. Future research may benefit from exploring satisfaction across specific healthcare sectors (eg, the Ministry of Health, private, and university hospitals) or evaluating the impact of specific training interventions longitudinally.
Strengths and Limitations
This study is the first of its kind in Saudi Arabia to explore the factors associated with pediatricians’ satisfaction with managing DBDs, thereby addressing a significant gap in the national literature. The inclusion of pediatricians from diverse regions across all professional levels, including trainees, specialists, and consultants, enhanced the breadth and relevance of our findings. The use of a previously validated questionnaire strengthened the methodological rigor of the study and ensured the reliability of the collected data.
The response rate was 16%, which may have introduced a non-response bias and limited the external validity of the findings. The cross-sectional design precludes the ability to establish causal relationships between the factors examined and satisfaction levels. As the data were self-reported, there was a potential risk of recall and social desirability bias, which may have influenced the participants’ responses.
6. CONSLUSION
This study provides valuable insights into the factors influencing pediatricians’ satisfaction with the management of DBDs in Saudi Arabia. These findings highlight the critical role of clinical exposure and institutional support in shaping pediatricians’ comfort and confidence in addressing these conditions. The use of a diverse, nationally representative sample and a validated survey tool strengthens the study’s ability to reflect the real-world interplay between training, practice characteristics, and service availability.
However, the cross-sectional nature of the study and its reliance on self-reported data limit the ability to draw causal inferences and may introduce a response bias. Notably, higher satisfaction was observed among Saudi pediatricians, those trained locally, and those with more years of professional experience. These findings emphasize the need for future longitudinal studies, stratified analyses by region and subspecialty, and the evaluation of targeted interventions to enhance pediatricians’ preparedness and improve the quality of developmental care across healthcare systems in Saudi Arabia.
Recommendations
Based on the findings of this study, the following recommendations are proposed to improve pediatricians’ satisfaction with and competence in managing DBDs in Saudi Arabia:
a) Integrate structured DBP training into pediatric residency programs across Saudi Arabia with a focus on early identification, diagnosis, and management strategies.
b) Expand continuing medical education opportunities targeting developmental and behavioral topics, particularly for general pediatricians working in community and primary care settings.
c) Strengthen institutional infrastructure by establishing dedicated developmental-behavioral clinics, referral pathways, and multidisciplinary teams to support pediatricians in clinical decision-making.
d) Promote mentorship and supervision programs, particularly for early-career pediatricians, to enhance clinical confidence and reduce variability in practice.
e) Encourage further research, including longitudinal and interventional studies, to evaluate the long-term impact of training and systemic changes on pediatricians’ satisfaction and patient care outcomes.
f) Support regional and subspecialty-level need assessments to tailor interventions and resource allocation based on local challenges and capacities.
Acknowledgement:
The authors express their sincere gratitude and appreciation to the Saudi Commission for Health Specialties (SCFHS) for their support in distributing the questionnaire electronically to all Pediatricians in Saudi Arabia.
Patient Consent Form:
All participants were informed about subject of the study.
Author’s contribution:
F.O.A. conceived of the presented idea, curated the data, developed the methodology, administered the project, and supervised the research. He also provided critical feedback on the manuscript and helped with editing. R.H.A. (R.H. AlAttas) performed the formal analysis. I.H.A. provided the resources and contributed to the review and editing of the manuscript. R.H.A. (R.H. Alhakeem) provided the software and contributed to the writing of the original draft. S.A. and A.A. validated the analytical methods. D.W.A. and S.H.A. created the visualizations. M.M.A. and H.A.J. contributed to the writing of the original draft. B.E.A. (B.E. Alabbas) and B.E.A. (B.E. Alabkari) assisted with the review and editing of the manuscript. All authors have read and agreed to the published version of the manuscript..
Conflict of interest:
The authors declare that there is no conflict of interest.
Financial support and sponsorship:
The authors received no specific funding for this work. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
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