Developmental-Behavioral Pediatrics: Residency Rotation + Fellowship Program

During the first year of training, fellows are primarily engaged in developing skills in the clinical evaluation and care of patients and families presenting with developmental and behavioral concerns. Following an intensive summer training series involving opportunities to learn and practice hands on skills in assessment and evaluation, fellows embark on a robust and well mentored journey in patient care.  First year fellows work closely with our interprofessional faculty in bother early childhood (ECC) and school aged (LEAP) teaching clinics (see below).  Fellows acquire the skills necessary to obtain a developmentally-oriented patient history, perform thorough physical and neurological examinations, conduct developmental assessments, interview children and adolescents and interpret behavioral questionnaires in order to formulate a comprehensive and holistic understanding of the child and the psychosocial environment impacting functioning of the child and the family. Using a shared decision model the fellow will work with the patient, the family and community resources to develop individualized interventions. Fellows begin gaining knowledge of behavioral management strategies, pharmacological therapies (if needed) and other intervention modalities (speech and language therapy, psychology, etc.). The first year fellows also play a critical role in the teaching program by developing their own teaching and leadership skills through mentorship of the rotating residents and trainees at the CCSN

The clinical training is accompanied by a comprehensive series of didactic seminars on developmental-behavioral topics and research modalities that are relevant and informed by curriculum requirements for ABP sub-board certification. Regularly scheduled, cross-departmental conferences and seminars create an unusually collaborative environment for trainees.

During the first year of training, the fellow has 2 months of dedicated research time set aside to identify a topic for their scholarly project, assemble a scholarship oversight committee, and develop and submit a completed application as necessary to the Institutional Review Board (IRB). When applicable, fellows are provided a self-guided reading month to intensively study for their general pediatric board examination.

During the second year of training the fellow's clinical time is spent primarily in Fellow's Clinic providing continuity of care to their established patients and continuing to refine their clinical skills by evaluating new patients more independently. Additionally the fellow rotates through specialty clinics such as School consultation and NICU Follow-Up program. Fellows may also begin to rotate through sub-rotations in other relevant subspecialties (neurology, psychiatry, genetics, physical medicine and rehabilitation)

Mentorship of first year fellow is a powerful experience for the second year fellow which provides opportunity to solidify their own knowledge of DBP practice, and further develop teaching, mentoring and professional skills.

During the second year, the fellow has four months of dedicated research time to actively pursues their research projects and meet regularly with their mentor and scholarship oversight committees (SOC). Presentation skills are refined during research work- in- progress talks and fellows are encouraged to submit abstracts for regional and national meetings.

Fellow participation in the 10 month LEND (Leadership Education in Neurodevelopmental Disabilities) Program may occur in either the second or third year, depending on the fellow's individual learning plan.

The third year of training generally offers the most flexibility depending on a fellow's career aspirations.  Priorities include completion of a scholarly project involving the preparation and submission of a manuscript for peer review and submission.  The fellows typically have 6 months of dedicated time to their research project.

The third year fellows continue to hone their clinical skills in weekly Fellows Clinic where they have opportunities to teach and mentor pediatric residents and other trainees.  They continue to gain skills and independence in patient care that involves new evaluation and follow up care, medication management, and family advocacy.  They also are provided opportunities to work with program administration and quality improvement.  Fellows continue to gain experiences in other subspecialty rotations.

Fellows participate in our LEND program in which they focus on policy and system issues that have an impact on the lives of children with chronic health problems and disabilities.
 

The LEND Program provides Fellowships in interdisciplinary leadership training to health care professionals, teachers and family members who have had experience working with children or adults with disabilities and their families.

In a milieu that is designed to nurture and challenge potential leaders, fellows attend seminars, conduct projects pertinent to improving maternal and child health service delivery systems, develop partnerships with families, engage in grant writing, and participate in outcome and other research projects.

Over the course of the year, Fellows gain in-depth knowledge of the systems within which people with special health care needs and their families live and work, improve their interpersonal leadership skills, and work on the development of their own vision of change. Many of the seminar sessions are given by today's leaders in the field, encouraging the development of a network system that will continue beyond the fellowship year.

As a result of a unique relationship with Suffolk University, fellows have the option to have their LEND coursework be credited toward a Master's degree in Health or Public Administration. Details about this program can be found on the EK Shriver Center LEND Program Web site.

How to Apply to the Fellowship Program:
 

The fellowship accepts applications through ERAS. Selection is through the National Resident Matching Program.

For further information about Developmental-Behavioral Pediatrics Fellowship:

Hina Iqbal
Pediatric Fellowship Coordinator
Tufts Medical Center
hina.iqbal@tuftsmedicine.org

Core Clinical Experience

Early Childhood Clinic (ECC): ECC is an interdisciplinary clinic co-directed by speech and language pathology and developmental behavioral pediatrics. Fellows and other trainees develop history taking skills and developmental assessment skills across a spectrum of concerns for toddlers and preschool children. The ECC experience is an excellent opportunity to learn about motor, language, cognitive, and social-emotional development. Trainees learn the components of history taking when evaluating a young child for autism, or behavioral / developmental concerns and the communication skills needed to work with caregivers and children.  Trainees learn how to select, score and interpret appropriate screening tools and rating scales. Fellows receive training on administration and reporting of standardized developmental testing (such as Autism Diagnostic Observation Schedule-ADOS), and how to integrate observations and test results into comprehensive diagnostic formulation. A key skill developed in ECC is effective and compassionate communication of diagnostic findings leading to treatment planning using shared decision-making and personalized goals. Faculty serve as clinical mentors who guide fellows and other trainees in developing all of these skills, learning to communicate with families and community agencies, and in writing comprehensive reports that can be utilized for patient advocacy and care.

Learning, Education, and Attention Program (LEAP): LEAP clinic is an interdisciplinary clinic co-directed by social work and developmental behavioral pediatrics. Neuropsychology, Speech and Language and Social work interns often spend rotations as part of the LEAP team. Fellows develop child interview and assessment skills across a broad spectrum of concerns for school-age children and expand their capacity to interact with schools, community services and behavioral health providers. Residents and other trainees are integrated into the evaluation team.  Faculty serve as clinical mentors who guide fellows on interviewing skills, administration of various cognitive, academic, language, and social-emotional instruments to inform and reflect on complex patient concerns and to develop plans moving forward.  Fellows gain keen understanding of attention, learning, and social difficulties. Leadership opportunities and team participation prepare fellows and trainees to work within a collaborative, interprofessional environment.

Fellows' Clinic: During a Fellows first year, Fellows' Clinic serves as a venue to follow-up on their own patients who have been diagnosed by them in ECC and LEAP Clinics. They will also assume the care of patients who had been previously followed by graduating fellows. In addition to longitudinal care and management, a major goal of this clinic is for the fellow to learn counseling skills and pharmacological management. Faculty serve as clinical mentors and encourage the fellows to develop increasing autonomy in decision making and patient management.  Residents and other trainees participate by providing observation of child and parent behaviors and involvement in discussion of cases.
 

Elective Opportunities

Neonatal Follow-up Clinic: The NICU Follow-up Clinic is a multidisciplinary team clinic that takes place twice a week at The Center for Children with Special Needs.  The Divisions of Developmental-Behavioral Pediatrics and Newborn Medicine collaborate closely and have graduated two fellows with dual board certification. Developmental-Behavioral Pediatrics fellows rotate in NICU follow-up clinic as team members. They interview families and update medical and developmental history. They assist in the developmental assessment and have the opportunity to learn the Bayley 3. Fellows consult to the team when a child shows signs of autism or developmental disability. Other trainees do structured observations. Goals of this rotation include learning about the developmental consequences of prematurity, early signs of cerebral palsy, family adaptation to disability, Early Intervention (EI) and connection with community resources.

Medical Genetics: A solid understanding of genetics, genetic testing and genetic counseling principles are essential to the practice of Developmental Behavioral Pediatrics. This rotation is a combination of independent study, clinical experiences and field trips. Independent study includes online coursework and core articles in order to review and augment knowledge base in medical genetics, dysmorphology and genetic syndromes. Fellow will attend clinic with Tufts geneticists and participate in consultations in the newborn nursery. Fellow will observe genetic counseling sessions and learn how to explain genetic findings and the limitations of genetic testing.

Child and Adolescent Psychiatry: Developmental Behavioral Pediatrics requires a comprehensive knowledge of child psychiatry. Child psychiatry and child psychology training occur throughout the fellowship program. The Center for Children with Special Needs includes faculty in psychology, neuropsychology and social work who participate in CCSN clinics and activities. Fellows have frequent interaction with their trainees. DBP and Child psychiatry fellows participate in a seminar series exploring child development from a psychodynamic perspective. Neurobehavior Conference is a monthly case-based conference involves child neurology, child psychiatry and Developmental Behavioral Pediatrics faculty and trainees. The Child and Adolescent Psychiatry rotation includes independent study, didactics, conferences, and field trips. Independent study emphasizes foundation knowledge of Child and Adolescent Psychiatry and psychiatric disorders less often encountered at a CCSN clinic such as eating disorders, somatization and severe mental illness. Developmental-Behavioral Pediatrics fellows participate in psychiatry lectures and conferences. Clinical experiences include participation in teaching clinics and psychiatry consults on the inpatient floors.  Field trips include visits to psychiatric inpatient unit for children and/or community-based acute treatment (CBAT) program.  Advanced study in psychopharmacology is available.

Pediatric Physical Medicine and Rehabilitation: The rotation in Physical Medicine and Rehabilitation (PM&R) also called Physiatry expands the fellow's understanding of the full range of developmental problems involving physical disabilities.  The rotation involves rotation at Franciscan's Children's Hospital where they will have opportunity to learn about the identification and management of neuromuscular disorders, cerebral palsy and its complications and treatments and sensory disorders -visual and hearing impairments.

School Rotation: School Rotation provides fellows with a unique, comprehensive "inside view" of schools and education that is necessary in Developmental Behavioral Pediatrics.  Fellow works closely with a Developmental Behavioral Pediatrician who provides consultation to the Brookline Public Schools.  School Rotation includes independent study, clinical experiences and field trips.  Independent study focuses on acquiring in-depth knowledge of educational law, educational systems and standardized testing interpretation.  Typical acquisition of academic skills will be contrasted with delayed or disordered learning.  The fellow will learn how social emotional aspects of development impact on school function.  Key clinical experiences include working collaboratively with school teams and parents and acquiring consultation skills. Field trips include observations of typical classroom and school-based related service delivery (e.g. occupational therapy) as well as visit to specialized school settings for more severe disabilities.

Educational/Didactic Opportunities

Fellows participate in a range of lectures, seminars and clinical care conferences.  Emphasis is placed on the development of individual learning and research plans.

We are a teaching unit of the Tufts Medicine program and Tufts University School pf Medicine.  We participate in multiple teaching programs including the medical school, physician assistant program and dental school. All pediatric residents rotate though the CCSN, as well as child psychiatry and trainees from a broad range of disciplines.  Fellows are an integral part of our teaching program and are expected to participate in the clinical precepting and seminar presentations that we provide. 

Weekly

• Developmental Behavioral Pediatrics fellow's seminars (combined with Boston Medical Center-Boston Children's)
• Clinician Meetings (CCSN)
• Leadership Education in Neurodevelopmental and Related Disabilities (LEND) (2nd or 3rd year)
   

Monthly

• Neurobehavioral Conference held jointly with Developmental Behavioral Pediatrics and Child Psychiatry.  The DBP fellows each present once/year. Participation allows fellows to meet competencies in: patient care, medical knowledge, interpersonal and communication skills, professionalism, practice based learning and environment, and systems-based practice.
• Research Seminar Series
   

Other

• Critically Appraised Topic (Journal Club): Fellows attend the quarterly Developmental Behavioral Pediatrics Journal Club. Using critical appraisal skills, fellows learn how to evaluate and present evidence. Participation allows fellows to meet ACGME competencies in: medical knowledge, practice based learning and improvement, evidence based practice, research skills (clinical research methods and biostatistics), and interpersonal and communication skills.
• Works in Progress. Fellows attend quarterly Developmental Behavioral Pediatrics Works in Progress. Through these sessions, fellows present their work and engage in discussion of their scholarly project throughout the stages of development.
   

Research, Funding, Publications, Advocacy, Quality Improvement

Scholarly work is an important aspect of DBP fellowship training. Knowledge of research design is gained through didactic experiences including a dedicated research seminar series, journal clubs, work in progress seminars, and research seminars. A key aspect of planning, carrying out, and completing a successful research project centers around the fellow's individual meetings with their research mentor.

Year 1:  The fellow will use their protected time to identify a research mentor and begin to develop an outline of a scholarly project in their area of interest, including a review of the literature, development of a research question, and establishment of a timeline. The fellow will additionally identify faculty for their Scientific Oversight Committee and submit a research plan to the Institutional Review Board as appropriate.  

Year 2: The fellow will gather data, meet with their SOC regularly, present their work at a research in progress seminar, and consider submitting an abstract for the Society for Developmental Behavioral Pediatrics in the fall of their third year.

Year 3: The fellow will complete data collection and begin the analysis process. The fellow continues to meet with their mentor and SOC, and begin the process of writing a manuscript for submission to a peer-reviewed journal. They may be presenting at the SDBP in the fall of their third year and submitting an abstract to the Pediatric Academic Societies for presentation in the Spring. 
 

The CCSN supports an environment of curiosity, reflection and questioning within a multidisciplinary setting, and we aim to provide trainees with the skills needed to support the next generation of clinical scientists.  We strive to promote innovation, knowledge, and evidence-based practice in the field of behavioral and developmental pediatrics.  We are also committed to providing a high quality of care to the families that we see, and actively explore quality improvement projects that enhance patient experiences and supports the unique experiences and well being of our patient population.  Our faculty, clinical staff and trainees are committed to the scholarly pursuit of projects and topics of personal meaning, and have presented findings in professional conferences (e.g., The Society for Developmental and Behavioral Pediatrics (SDBP), Pediatric Academic Societies (PAS), National Association of School Psychologists (NASP), International Neuropsychological Society (INS).

Recent and active projects by faculty and trainees have included:

• Development of standardized developmental and social-emotional screening tools (SWYC)
• Developmental and Behavioral Pediatrics Recent Scholarship
• Yu-Hsun Amy Wang was recently awarded a NIH funded TL1 appointment with the Tufts Clinical and Translational Science Institute.  During her 12 months of study, Dr. Wang will gain experience in working in a cross disciplinary research training environment to broaden her expertise to inform her ongoing academic interests and projects
• Recently Presented Projects (2023 Maternal Child Health Bureau Annual Meeting) Current Trainee Research projects:
  Yanira Belen Espinosa, Tufts Medical Center
• "Validating Measures and Unpacking Differences in Service Use for Diverse
  Children with Autism"
  • Irmina Stec, Tufts Medical Center

"Sexuality and Relationship Education for Teens with Autism Spectrum Disorder"

• Yu-Hsun Amy Wang, Tufts Medical Center
   

"Self-Harm Behaviors and Comorbid Mental Disorders in Children with
Attention-Deficit/Hyperactivity Disorder: A National Wide Study"

Quality Improvement Projects

• CARE Parent Support Group
• Weekly virtual parent group:  designed for families and caregivers who have recently been through an evaluation at out center and are seeking out information, mentorship and connection in supporting the needs of their neurodiverse family members
• Transition Support
• PATH Program: Promoting Adolescent Transitions in Health Care
• Supporting youth and their families in identifying their personal goals and needs as they prepare for the transition to adult healthcare and services process. 

Irmina Stec, DO
Irmina Stec graduated from Midwestern University Arizona College of Osteopathic Medicine and returned home to Chicago to complete her pediatric residency at Advocate Children’s Hospital - Park Ridge. Dr. Stec enjoys caring for children from immigrant and underserved communities and educating their families about various healthcare topics. Originally from Poland, Dr. Stec realizes the need for a Developmental-Behavioral Pediatrician that can cater to Chicago’s large Polish population. Upon completing her fellowship training, she hopes to educate the general public, especially Polish populations in the United States, about various developmental and behavioral issues, including autism spectrum disorder. Her research interests involved work on a sexuality and relationship educational project for teens with Autism.

Yu-Hsun Amy Wang, MD
Amy graduated from National Yang-Ming University in Taiwan and completed her pediatric residency in Texas. While volunteering with Aboriginal children in Taiwan, Amy became interested in working with families and children with developmental differences. Amy enjoys working in multi-disciplinary teams to form diagnostic impressions and treatment plans. Her research interests include exploring the link between self-harm behaviors and comorbid mental health disorders in children with Attention-Deficit/Hyperactivity Disorder.

Yanira Belen Espinosa, MD
Belen Espinosa graduated from Pontificia Universidad Catolica del Ecuador and completed her residency at Woodhull Medical Center in Brooklyn, New York, in 2022. Dr. Espinosa worked to establish and implement health education projects with underserved populations in her country. During her residency, she developed a Quality Improvement project to improve the Development Screening practices in the Primary Care Clinic. She hopes to return to her country to establish a support program for children with special needs.

Alumni 2022
Cristina Bird Collado, MD: Assistant Professor of Pediatrics, Tufts MEDICINE, Boston, MA

Cristina M. Bird Collado graduated from Universidad Central del Caribe School of Medicine and completed her residency in General Pediatrics at San Juan City Hospital in San Juan, Puerto Rico in 2018.  Dr. Bird Collado has always been passionate about providing care to underserved communities. In doing so, she recognized the need to integrate healthcare into community settings. After completing her pediatric residency, Dr. Bird Collado completed a research fellowship, supporting pediatric residents on the development and implementation of their projects. Dr. Bird Collado is enthusiastic about helping children with special needs in her community receive the medical care they need to achieve their potential. Her research interests include early identification of autism and other developmental disorders, and the promotion of bilingualism in Latin communities.

Alumni 2021
Deanna Lau, DO: (2021): Developmental-Behavioral Pediatrics, Providence Medical Grp Santa Roada, CA

SDBP Abstract Presentation SDBP: Accoication of Comorbid Disorders on Timely Recepipt of Autism Diagnosis

Deanna Lau completed her residency in General Pediatrics at Coney Island Hospital and State University of New York Downstate. Prior to attending medical school at Touro University, California, she served as a research coordinator for participants in studies using web-based testing to establish the relation between symptom profiles regarding attention and cognitive testing scores along with heritability estimates for working memory and response inhibition at the University of California Los Angeles Semel Institute. While there, she also helped create an online knowledge base and assessment development project on Autism Spectrum Disorders. During her Pediatrics Residency, she worked with her Program Director to successfully attain a New York State Office of Mental Health grant to implement Healthy Steps, a model of delivering primary care which seeks to address adverse childhood experiences and improve developmental outcomes within the Pediatrics Clinic. Dr. Lau is passionate about state and national advocacy for policies to help children with special needs reach their potential and providing care for medically complex children. Her research interests include addressing cultural barriers within Asian communities in seeking appropriate diagnosis and care for children with developmental delay and Autism Spectrum Disorders screening tools.

Alumni 2020
Aseel Al Jadiri, MD (2020):

Assistant Professor of Pediatrics; Institute for Child Development; HMH Hackensack University Medical Center, Hackensack, NJ

Al-Jadiry AM, Al-Jadiri A. Autism from Leo Kanner to ICD-11 and DSM-5. Arab Journal of Psychiatry. 2019: 31(2): 100-114

Al-Jadiry AM, Al-Jadiri A. Neurodevelopmental Disorders and the Role of Parmacotherapy: Review and Update. Arab Journal of Psychiatry. 2020; 32(1): 1-16.

Al-Jadiri A, Tybor DJ, Mulé C, Sakai C. Factors Associated with Resilience in Families of Children with Autism Spectrum Disorders. J Devel Behav Pediatr. 2020; 42(1): 16-22

Alumni 2018
Kathleen Pitterle, DO (2018)

Assistant Professor of Pediatrics, Nemours/Dupont Hospital for Children, Wilmington, DE
Pitterle K, Sakai C, Mulé C. "Comparing Flourishing between children with Attention Deficit Hyperactivity Disorder and Asthma." Poster at the Society of Developmental Behavioral Pediatrics Annual Meeting. 2017; Cleveland OH.

Amel Al Awami, MD (2018)
Developmental Behavioral Pediatrician, John Hopkins ARAMCO Healthcare, Saudi Arabia

Alawami AH, Perrin EC, Sakai C. Implementation of M-CHAT Screening for Autism in Primary Care in Saudi Arabia. Glob Pediatr Health. 2019 May 31;6:2333794X19852021

Alumni 2017
Bibiana Restrepo, MD (2017)
Assistant Professor of Pediatrics, MIND Institute, UC Davis, California

Diemer M, Restrepo B, Perrin E, Sheldrick R, Garfinkel D, Bevan S. "Increased costs of identifying developmental-behavioral problems in non-English speaking families." Poster at the Society of Developmental Behavioral Pediatrics Annual Meeting. 2017; Cleveland OH.
Alumni 2016:

A. Stacie Colwell, MD, PhD (2016)
Pediatric Palliative Care, Assistant Professor of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada

Alumni 2015
Carmina Erdei, MD (Combined Fellowship in Developmental Behavioral Pediatrics and Newborn Medicine, 2015):
Lead Physican, Growth and Development Unit, Brigham and Women's Hospital Instructor in Pediatrics, Harvard University Medical School 
Fellowship Publications:

C Erdei: Infectious Behavior: Brain-Immune Connections in Autism, Schizophrenia, and Depression Journal of Developmental & Behavioral Pediatrics: Volume 34  (5 ): 374, 2013 (Book Review)

C Erdei and O Dammann: The Perfect Storm: Preterm Birth, Neurodevelopmental Mechanisms, and Autism Causation. Perspectives in Biology and Medicine 57 (4): 470-481, 2014 (10.1353/pbm.2014.0036)

Alumni 2014
Christina Sakai, MD (2014)

Developmental Behavioral Pediatrician, Center for Children with Special Needs, Tufts Medical Center; Assistant Professor, Tufts University School of Medicine
 

Fellowship Publications/Presentations: 

Sakai C, Mackie TI, Shetgiri R, Franzen S, Partap A, Flores G, Leslie LK. Mental Health Beliefs and Barriers to Accessing Mental Health Services in Youth Aging Out of Foster Care. Acad Pediatr. 2014 Nov;14(6):565-573.

Sakai C, Miller K, Brussa AK, MacPherson C, Augustyn M. Challenges of autism in the inpatient setting. J Dev Behav Pediatr. 2014;35(1):82-84.

Sakai C, Tavel-Gelrud D, Choueiri R. "How Do Latino Families Perceive Autism Diagnosis and Management? Experiences of Early Intervention Providers." Poster at the Society for Developmental Behavioral Pediatrics Annual Meeting, September 22, 2014; Nashville, TN and at Pediatric Academic Societies Annual Meeting, May 3, 2014; Vancouver, BC, Canada.

Sheryl Levy, MD (2014)
Developmental Behavioral Pediatrician, Center for Children with Special Needs, Tufts Medical Center; Assistant Professor, Tufts University School of Medicine 
Fellowship Publications:

Levy, S, Hill, E, McKay, K, Sheldrick RC, Perrin EC.  Co-located mental health/developmental care.  Clinical Pediatrics, 56 (11): 1023-1031, 2017

Alumni 2009-2011
Nicola Smith, MD (2011):
Developmental Behavioral Pediatrician, Child and Adolescent Health, Cohasset, MA 
 

Fellowship Publications:  
Smith NK, Sheldrick RC, and Perrin EC. (2012).  An Abbreviated Screening instrument for autism spectrum disorders. Infant Mental Health Journal. DOI: 10.1002/imhj.21356.

Catherine Davis, MD (2009): Developmental Behavioral Pediatrician, Harvard Vanguard Medical Associates, Burlington, MA 
Fellowship Publications:

C  Davis, M Claudius, L Palinkas, J  Wong, L Leslie: Putting Families in the Center Family Perspectives on Decision Making and ADHD and Implications for ADHD Care. J Attention Disorders: Volume: 16 (8): 675-684, 2011.

Paige Church, MD
Director, Neonatal Follow Up Clinic, Sunnybrook Health Sciences Centre, Toronto, Canada
Fellowship Publications:

Multicenter Collaboration with many authors including Paige Church: Video and CD-ROM as a Training Tool for Performing Neurologic Examinations of 1-Year-Old Children in a Multicenter Epidemiologic Study: J. Child Neurology: 20 (10): 829-831, 2005

Deb Shipman, MD
Developmental Behavioral Pediatrician, Reliant Health, Massachusetts
Fellowship Publications:

Shipman DL, Sheldrick RC, Perrin EC. Quality of life in adolescents with autism spectrum disorders: reliability and validity of self-reports. J Dev Behav Pediatr. 2011 Feb-Mar; 32(2):85-9.

Sheldrick, R.C., Neger, E., Shipman, D., Perrin, E.C. (2011). Quality of life of adolescents with autism spectrum disorders: Concordance among adolescents' self-reports, parents' reports and parents' proxy reports. Quality of Life Research, 21(1), 53-57. DOI: 10.1007/s11136-011-9916-5; PMID 21505880. 

One in five children has a "special healthcare need", and behavior and development are relevant to ALL children.  Despite this relevance, many pediatricians feel under-trained to identify and manage the developmental and behavioral challenges of their patients.  YOU as the pediatrician and medical home provider will be among the most pivotal and continuous individuals responsible to the infant/child/adolescent and caregivers for following their developmental and behavioral needs; identifying special needs; shepherding families toward more specialized services; serving as an advocate for families; and other roles.  Although developmental pediatricians can assist you in your primary role as the general pediatrician, the ball will still primarily be in your court to take the lead for the vast majority of your patients with special needs, and for all your patients in general.

Because your role as primary care provider is so singularly influential, the Pediatrics Residency Review Committee (RRC) requires a minimum of one month of DBP during pediatric residency training.  Currently, at Tufts, this is accomplished by a 4 week rotation in your intern year. While Family Medicine Residency programs do not yet require a DBP rotation, Tufts Family Medicine recognized the need for DBP training in their own practices and arranged this rotation to fill that need.  The focus of this rotation will be general developmental/behavior as well as children with special needs.  The resources provided in this rotation can be used throughout your residency training as you manage the needs of children in your outpatient continuity clinic, subspecialty rotations, in the emergency department, and on inpatient services.  The intended outcome is to leave you with the tools and strategies you will need to identify, manage and support your patients and their families with greater confidence.

This will be accomplished through participation in patient evaluations and discussion with clinicians about specific cases; Required readings, videos, and self-learning modules; quizzes, including a pre-test and post-test, field-trips to Early Intervention, a child care center, schools; and other written and/or creative assignments that allow you to demonstrate your understanding and thinking.  There is time set aside for you during some weekdays and of course during your evenings and free weekends, to complete assigned work.

We welcome all feedback and suggestions from you.  We realize that there is a great deal to accomplish over the month, but in the end we feel that your knowledge of Developmental-Behavioral Pediatrics will serve you well throughout your training and in whatever you choose to pursue for your career.

We hope you will learn a lot and enjoy your time here.  The clinicians here are committed to educating residents so that you can provide the best care for children in the future.

DBP Experience: Overview and Structure: 
A. PLI Core Rotation in Developmental Disabilities:

Your rotation will consist of many activities that are designed to provide you with a broad-based, well-rounded exposure to the subspecialty of Developmental-Behavioral Pediatrics (DBP) and to explore normal child development.   Most of your scheduled activities will take place in the 2nd floor of Tufts Medical Center.  In addition to clinics and evaluations within the CCSN, there are several activities that take place outside of the Tufts Medical Center.   
                                                             

Weekly Schedule: 

Goals and Objectives Developmental Behavioral Pediatrics Experiences

There are two components to a family practice resident’s experience in Developmental-Behavioral

Pediatrics (DBP):

• 2 week PLI Core Rotation in DBP.
• Self-Learning modules, two didactic meetings with attending

1. PLI Core Rotation in Developmental Behavioral Pediatrics

2. Self-Learning Modules on the pediatric resident google drive to be covered during two didactic meetings during their two week DBP rotation

DBP Experience: Overview and Structure:

The two week rotation has several components: observations, evaluations, field trips and self-directed learning.  The resident has the opportunity to observe a broad range of professionals- from DBP to speech pathology.  The resident contributes to the data gathering on a patient as a member of the Learning Effectiveness Attention Program Clinic (LEAP).  The DBP rotation includes Field Trips!  The resident observes typically developing children in a large child care center and has the opportunity to observe delivery of therapy to infants and toddlers in an Early Intervention Class.  

Schedule for the 2 week elective:

Goals and Objectives for the Family Medicine Rotation in Developmental Disabilities 
 

Autism Spectrum Disorders (ASD). Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with ASD.

• Use history and observation to identify children with social interaction difficulties and communication impairments.
•  Recognize developmental milestone red flags for ASD (absence of joint attention- eye contact and pointing- by 9-12 months, absence of pretend play by 18 months, language delays)
• Generate a differential diagnosis for ASD.
• Be familiar with appropriate long-term management techniques and evidence-based components of an effective educational/behavioral program for children with ASD.

Developmental Delay. Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with developmental delays

• Identify children with developmental delay and generate a differential diagnosis for the child with persistent delays, including motor delays (e.g., pre-/peri-natal factors, environmental, metabolic/genetic)
• Understand the components of the IFSP (Individual Family Services Plan) through Early Intervention (EI).
• Understand therapy and treatment needs of children with GDD/ID across the age spectrum

School Performance. Understand the primary care provider’s role in the promotion of school performance and the evaluation and management of school problems in children and adolescents.

• Participate in the evaluation of a child with inadequate school performance that includes input from the child, family, and school.
• Observe the evaluation tools used to evaluate children and adolescents during the course of psychoeducational testing
• Generate a differential diagnosis for the child with inadequate school performance.
• Understand the medical considerations that contribute to poor school performance (ADHD, Anxiety/Depression, Psychosocial stressors, Chronic illness- asthma/diabetes, sleep deprivation)
• Provide anticipatory guidance to families of school-aged children about habits that promote school performance (sleep, nutrition, exercise, daily routines, limiting media exposure, completing homework, parental involvement in school activities, etc).
• Understand the role of a 504 accommodations plan vs. an IEP for children and adolescents with school difficulties
• Review key components of an IEP (Individual Education Plan) with the family 

Review available information from parents, early intervention programs, schools, community agencies, and prior medical consultations to inform diagnosis and management 
 

Recognize the role of specialists, referral processes, and case management across multiple disciplines to care for children with developmental disorders. This may include the following professionals:

1. Social Worker/Family Counseling 
2. Early intervention services 
3. Educational intervention (preschool and school age) 
4. Clinical Psychology and/or Neuropsychology 
5. Child psychiatry 
6. Community Resource Specialist 
7. Developmental-Behavioral/Neurodevelopmental Pediatrician 
8. Occupational therapy 
9. Physical therapy 
10. Speech/language therapy 
11. Physical medicine and rehabilitation