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Developmental and Behavioral Pediatrics Rotation

Benhaven

Mandatory Readings

Health Care for Individuals with Developmental Disabilities

Goals & Objectives

Goal

To have a greater knowledge of community resources for children with autism and other developmental disabilities.

Objectives

Residents will visit Ben Haven, a local school and residential program for older children and adolescents with autism and cognitive disabilities. They will attend a multidisciplinary case review at the residence or a didactic training for educators at the school.

Satisfying this goal will improve core competencies in:

  • Systems Based Practice as residents will have a greater understanding of the diversity of systems involved in providing care for children with developmental disabilities and a greater understanding of how these systems integrate physical and mental health care with educational services to meet the complex needs of these children. In addition, residents will have a greater knowledge of how to collaborate with other providers of care to children.
  • Medical knowledge: Residents will learn about the atypical ways that patients with autism and severe cognitive impairment present when they have common medical problems such as GERD, sinus infections or UTIs.

Residents will have an opportunity during this rotation to attend team rounds with Dr. Avni-Singer at Benhaven, a residential facility for children with Autism who are significantly impaired. It's an opportunity to understand the range of complexities in caring for children with significant developmental disabilities and the role a pediatrician can play in consulting to a center

DBP Articles

Adoption & Foster Care

Assessment of Children

  • Melvin Lewis and Robert A. King. Psychiatric Assessment of Infants, Children and Adolescents. In Lewis M (ed): Child and Adolescent Psychiatry: A Comprehensive Textbook. (3rd Edition) Baltimore, Williams & Wilkins, 2002. pp 525-543.
  • Nancy E. Moss and Gary R. Racusin. Psychological Assessment of Children and Adolescents. In Lewis M (ed): Child and Adolescent Psychiatry: A Comprehensive Textbook. (3rd Edition) Baltimore, Williams & Wilkins, 2002. pp 555-572.

Attention Deficit Hyperactivity Disorder (ADHD)

Autism

Children's Understanding Illness

  • David J. Schonfeld. The Child's Cognitive Understanding of Illness. In Lewis M (ed): Child and Adolescent Psychiatry: A Comprehensive Textbook. (3rd Edition) Baltimore, Williams & Wilkins, 2002. pp 1119-1123.

Children with Special Health Care Needs

Developmental Delay/Intellectual Disability

Developmental Screening

Enuresis/Encopresis

Germ Talk
Schonfeld D and Quackenbush M. Teaching Kids About...How AIDS Works. A Curriculum for Grades K-3. Santa Cruz, ETR Associates, 1996.

  • Activity 3: If You're Sick, Can I Get It?
  • Activity 4: Getting Help When I Am Sick.
  • Evaluation: How Illnesses are Different.
  • Unit 2 - Different Ways to be Sick:
  • Activity 1: What is a Germ?
  • Activity 2: Seeing is Believing: Watching "Germs" Pass.
  • Activity 3: Serious & Not-So-Serious Illnesses.

Hospitalization

  • Avni-Singer AJ, Leventhal JM: Hospitalization of children. in Parker S, Zuckerman B (eds) Behavioral and Developmental Pediatrics: A Handbook for Primary Care. Boston, Little Brown and Co, 1995, pp 18

Learning Disabilities

Obsessive Compulsive Disorder and Tourette's syndrome

Play

  • Danette Glassy, Judith Romano and Committee on Early Childhood, Adoption, and Dependent Care. Selecting Appropriate Toys for Young Children: The Pediatrician's Role. Pediatrics. 2003. 111 p. 911-13.
  • Kenneth R. Ginsburg, and the Committee on Communications and Committee on Psychosocial Aspects of Child and Family Health. The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics. 2006, in press.

Psychopharmacology

Sexual Abuse of Children

  • Leventhal JM: Sexual abuse of children. in Hoekelman RA, Friedman SB, Nelson NM, Seidel HM, Weitzman ML. (eds) Primary Pediatric Care, 3rd Edition, St. Louis, Mo, Mosby, 1997, pp 651-656.
  • Leventhal JM: Sexual abuse of children. in Hoekelman RA, Weitzman ML, Adams HM, Nelson NM, Wilson MH. (eds) Primary Pediatric Care, 4th Edition, St Louis, MO, Mosby, 2001, pp 728-734.
  • Stephen J. Bavolek. The Nurturing Parenting Programs. In: Juvenile Justice Bulletin. Office of Juvenile Justice and Delinquency Prevention. United States Department of Justice, Office of Justice Programs. 2000.
  • Leventhal JM: Child maltreatment: Neglect to abuse. in Rudolf AM, Hoffman JIE, Rudolph CD, Siegel NJ, Lister G, Hostetter M. (eds) Rudolf's Pediatrics, 21st Edition, New York, McGraw-Hill, 2002, pp 463-470.
  • Nancy Kellogg, MD and the Committee on Child Abuse and Neglect. The Evaluation of Sexual Abuse in Children. Pediatrics Vol. 116 No. 2 August 2005, pp. 506-512.

Transitional Care

Well-Child Care

DBP Rotation Schedules

Block 9 (February 5 – March 4, 2009): Rebecca Taxier

Block 10 (March 5 – April 1, 2009):
Catherine Harris
& Carol Wittlieb

Block 11 (April 2 – April 29, 2009):
Adam Berkwitt &
Matthew Egalka
& Mohini Patel

Block 12 (April 30 – May 27, 2009):
Jill Colabroy &
Jessie Long

Block 13 (May 28 – June 25, 2009):
Sean Lang

Developmental Disabilities Clinic

Mandatory Readings

  • Identification and Evaluation of Children With Autism Spectrum Disorders
  • Management of Children With Autism Spectrum Disorders

Goals & Objectives

The section of the rotation in Developmental-Behavioral Pediatrics on learning about autism spectrum disorders (ASDs) and observing the autism clinics at the Child Study Center has the following goals and objectives:

Goal

To become familiar with the diagnostic criteria for ASDs and the differential diagnosis for children presenting with a possible ASD.

Objectives

  1. Residents will learn about the various components of the history and assessment that contribute to the overall clinical impression of ASD. For two patients at the Child Study Center autism clinics, they will observe the caregiver interview for developmental history, IQ and speech/language testing, and the Autism Diagnostic Observation Schedule (ADOS).
  2. Satisfying this goal will improve core competencies in:
    • Medical knowledge: Residents will develop a greater understanding of the wide range of phenotypes that is possible in ASD.
    • Patient care: Residents will have greater recognition of the warning signs of ASD among children in their practice.

Goal

To become familiar with the treatment plans for children with ASD.

Objectives

  1. Residents will learn about the medical, educational, and behavioral interventions commonly employed for children with ASD by attending the clinical team feedback sessions.
  2. Satisfying this goal will improve core competencies in:
    • Patient care: Residents will learn about the medications which are often used to treat maladaptive behaviors in ASD and of which they may help monitor the efficacy and side effects. Residents will learn about the educational and behavioral therapies that may be recommended for their patients and which they may need to advocate for on their patients' behalf.
    • Interpersonal and communication skills: Residents will become familiar with the large and diverse multidisciplinary team which often follows these patients and their role within that team.
  3. This rotation presents an excellent opportunity to observe diagnostic evaluations in the Yale Developmental Disabilities clinic and to participate in a multidisciplinary evaluation. The multidisciplinary team conducts evaluations that consist of psychological and developmental testing, psychiatric assessment and a speech, language and communication evaluation. At the conclusion of the assessment, prior to meeting with the family, the team will meet to discuss the results of the evaluation and recommendations for intervention.

Focused Developmental Evaluation Clinic

Goals & Objectives

Goal

To gain greater knowledge of the components of a brief and focused developmental assessment.

Objective

Residents will attend the FDE clinic which is held each week in the PCC and staffed by Birth to Three professionals who will conduct brief assessments of children who failed developmental screening.

Goals

To learn about community services for young children with suspected developmental delays. \

Objectives

  1. Residents will gain greater familiarity with early intervention services for children who fail developmental screens.
  2. Residents will understand criteria by which children in CT can qualify for EI services.

Satisfying these goals will improve competencies in:

  • Systems based learning
  • Medical Knowledge
  • Patient Care

Independent Learning Activities

At the completion of the rotation, residents will be asked to give a presentation on a topic of their choice during the weekly DBP seminar. This can be done with other residents also on rotation or independently. Please be prepared to review the literature and give an informative talk to DBP fellows and faculty on a specific topic related to DBP. If you prefer to do a project during the month rather than give a talk, this is possible and can be discussed with Dr. Weitzman.

Please read a book, view a movie or read a novel that relates to DBP and is aimed at children or adults. Please complete a review of this book using the DBP Book Review Form. Please see Dr. Weitzman if you would like suggestions.

Complete at least three modules in the Developmental & Behavioral Pediatrics Training Modules for Clinical Issues in Primary Care. Choose the cases that are of most interest to you. Ann Marie Healy has the discs for this. Please be prepared to discuss them and offer your critique.

Motivational Interviewing

Mandatory Readings:

  • Motivational Interviewing and Pediatric Health Behavior Interventions Mariann Suarez and Sharon Mullins. Dev Behav Pediatr 29:417–428, 2008.
  • Brief Motivational Interviewing as a Clinical Strategy to Promote Asthma Medication Adherence. Borelli, et al., J Allergy Clin Immunol, November 2007.

Residents will meet with Dr. Stahl twice during the rotation to become familiar with motivational interviewing and of its potential uses within pediatric primary care. Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Key to this process rests in the understanding that motivation to change is elicited from the client, and is not imposed. Motivational Interviewing is not meant to be a form or coercion or persuasion but an opportunity for parents to examine barriers and facilitators of change along with their doctor. It is a powerful tool that can strengthen parents' abilities to care for their children effectively.

Parenting 101

Mandatory Readings: Back to Basics: Attachment, Affect Regulation, and the Developing Right Brain: Linking Developmental Neuroscience to Pediatrics

Goals & Objectives

Knowing how to counsel parents effectively rests on understanding their concerns, hearing their stories and becoming more facile observers of the parent, the child and their interactions. What better place than in the laboratory (the well-child visit) before you?

During this rotation, on as many occasions as you can, go somewhere where parents and kids hang out (supermarkets, malls, playgrounds, etc.) On the enclosed form, note SPECIFIC behaviors that you observe to promote positive connection between parents and children and SPECIFIC behaviors that interfere. DON'T INTERPRET THE BEHAVIORS YET, JUST DESCRIBE THEM. Being specific means reporting — Mother bent down to be at eye level with the child vs. Mother was nice to the baby. Look for a range of interactions, both positive and negative.

Next, when you have finished your observations and feel you have gained some insight about promoting positive parent-child relations, go to the next page and create a summary list of what you think parents can do to create a positive interaction with their child.

Lastly—on the third page—practice seeing what it's like to talk about this during a well child visit in a way that is different from your current practice. Use some techniques gained through the Motivational Interviewing and the sessions with Dr. Avni-singer. Use your observations of the parent, the child and the interactions to narrate positive moments and explore difficult ones.

Talking to Families About Common Problems

Mandatory Readings: Chapters 1, 2 and 3 in Encounters with Children

Goals & Objectives

Goal

To develop knowledge and competency in understanding and assessing emotional development in young children.

Objectives

  1. Residents will learn about different theoretical constructs including Erickson's stages and Attachment theory. Each resident will then videotape at least one well child visit for review with a faculty member. Satisfying this goal will improve core competencies in:
    • Patient Care by learning to use observations of child behavior and parent-child interaction to make inferences on the child's emotional development. The resident will practice discussing these observations with parents during the visit.
    • Medical Knowledge: Residents will develop a greater understanding of the influence of the quality of early relationships in the development of emotional health and social competence.
  2. Interpersonal and Communication Skills: Residents will have a greater knowledge of how to create a therapeutic alliance with families through developing feelings of trust, openness and empathy.Residents will meet with Dr. Avni-Singer twice during the rotation to understand the impact of early childhood social-emotional development on future developmental and behavioral outcomes and consider new strategies to enhance communication with parents on this topic. As part of that experience, residents will be asked to videotape themselves during their continuity clinic. This is meant to be an educational, not evaluative experience and videotapes will only be viewed by the residents on rotation at that time and Dr. Avni-Singer. On the first session, Dr. Avni-Singer will explain more about the goals of this experience. Annmarie Healy has the cameras and you can sign them out through her.