The Tufts Developmental-Behavioral Pediatrics (DBP) Fellowship program has been ACGME accredited since 2005 and continues its passion for training knowledgeable, skilled and enthusiastic Developmental-Behavioral Pediatricians. As we are a smaller training program we can target a fellow’s individual interests and goals, while also completing requirements for board certification. We are part of the Center for Children with Special Needs (CCSN) which is a multi-disciplinary clinic that creates an inclusive interprofessional environment where DBP Fellows interact with other professional trainees and pediatric sub-specialty fellows. The CCSN sees a broad range of patients and serves a diverse population.
Contact Pediatric Fellowship Coordinator at nhernadez1@tuftsmedicalcenter.org.
During the first year of training, the fellow is primarily engaged in the clinical evaluation and care of patients with the spectrum of developmental and behavioral challenges and working with their families and community agencies. The majority of a fellow’s time (80%) is spent in acquiring the skills necessary to obtain a developmentally-oriented patient history, perform a physical and neurological examination, 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 physical layout of the clinics allows constant, direct observation and instruction of DBP fellows and the trainees of various levels and disciplines. The clinical training is accompanied by clinic-focused talks as well as comprehensive series of didactic seminars on developmental-behavioral, research, and teaching topics informed by the curriculum requirements for ABP sub-board certification. Regularly scheduled, cross-departmental conferences and seminars create an unusually collaborative environment for trainees.
First year fellows work closely with our interprofessional faculty in teaching clinics: Neuropsychology, Social Work, Education, Speech and Language, and the Autism Resource Specialist. They become comfortable in understanding the role of these professionals in the evaluation and support of children with the spectrum of developmental and behavioral challenges.
The first year fellow plays a critical role in the teaching program and develops their teaching skills through mentorship of the rotating residents and trainees at the CCSN. The teaching curriculum includes instruction in educational theory, the range of instructional methods and mentored presentations.
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). In addition, 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 (67%) 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. They get to solidify their own knowledge of DBP, practice teaching skills and provide feedback as well as modeling professionalism and interpersonal communication.
During the second year, the fellow has four months of dedicated research time and actively pursues their project, meeting regularly with their mentor and scholarship oversight committee (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 offers the most flexibility depending on the fellow’s career aspirations. Priorities include completion of the scholarly project such as the preparation and submission of a manuscript for peer-review and presentation at meetings. The fellow has 6 months of dedicated research time.
During the first year of Fellowship training, all clinical rotations are based at the Center for Children with Special Needs (CCSN) a tertiary referral center located within Tufts Medical Center. At the CCSN and its community satellites there are more than 5,000 patient visits/year, representing children with a broad range of developmental and behavioral concerns and who also represent children with complex care issues. Each clinic is closely precepted by a board certified/eligible Developmental Behavioral Pediatric attending and may also be co-taught by a member of the multidisciplinary team (Psychology, Social Work, and Speech and Language Therapies).
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 typical motor, language, cognitive, and social-emotional development and detection of red flags for atypical child development. Trainees learn the components of history taking when evaluating a young child for autism, or behavioral / developmental problems 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. Trainees acquire knowledge of the systems impacting young children including Early Intervention (under 3)and the school system (over 3) with the establishment of an Individual Educational Plan (IEP). Trainees become aware of the impact of these issues on the family dynamic including cultural issues, and learn community-based systems and services available for addressing these problems. 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 and thoughtful reports. Fellows gain expertise and become teachers themselves.
Learning, Education, and Attention Program (LEAP): LEAP clinic is an interdisciplinary clinic co-directed by social work and developmental behavioral pediatrics. In addition, neuropsychology and social work interns spend year-long 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, then guide the fellow on refinement of their clinical reasoning and reflect on adapting evidence-informed interventions to unique, family-centered situations. 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.
During the second and third year of training, the fellow continues to see patients at the CCSN, but also attends subspecialty clinics within the medical center and community-based programs. Subspecialty rotations are chosen both to fulfill the requirements of training as well as meet the individual fellow’s areas of interest
Fellow’s Clinic: During a Fellow’s second and third years, Fellow’s clinic continues to serve as a venue to follow-up on their own patients. Beginning in the second year, Fellow’s will additionally evaluate and follow new patients of all ages. A major goal of this clinic continues to be for the fellow to learn pharmacological management. Faculty serve as clinical mentors and encourage the fellows to develop increasing autonomy in decision making and patient management.
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. Rotation includes field trip experiences at an Early Intervention center and a child care center with typically developing children. Optional visits to Tufts Feeding Program which involves Occupational Therapy and Speech/Language Pathology. Optional attendance at a support group for parents of NICU patients.
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. Field trips will include observation in genetics testing lab and visit to chronic care facility to learn about genetic disorders across the lifespan.
Pediatric Neurology: Pediatric Neurology and Developmental Behavioral Pediatrics are closely linked subspecialties and there is also a subspecialty Neurodevelopmental Disabilities which combine the two fields. The pediatric neurology rotation includes independent study, didactics, conferences, clinical experiences and field trips. Independent study focuses on typical and atypical brain development, differential diagnosis of presenting symptoms such as developmental delays, hypotonia and atypical movements. Didactics include participation in neurology fellow seminars, EEG conferences and neurology grand rounds. Fellows attend Neurobehavior Conference-a monthly case-based conference with child neurology, child psychiatry and Developmental Behavioral Pediatrics faculty and trainees. Fellows rotate with several neurology attendings and are expected to increase their clinical reasoning regarding neurologic symptoms and be able to perform a comprehensive neurologic examination including minor neurologic signs. Field trips include pediatric neuroimaging reading room to learn to read and MRI systematically and observation of an EEG session and EEG review with neurologist.
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 independent study, clinical experiences and field trips. Independent study focuses on neuromuscular disorders, cerebral palsy and its complications and treatments and sensory disorders -visual and hearing impairments. Clinical experiences occur in several settings. At Tufts Medical Center the fellow will participate in clinics involving assessment and management of physical disability including discussion of bracing, mobility aids (wheelchairs, walkers, etc.) and medical treatments such as Botox. Field trips include a pediatric complex care inpatient center, Perkins school for the Blind and a school for children with hearing impairments. Optional visits to Tufts Audiology Cochlear Implant clinic.
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 with 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.
Leadership Education in Neurodevelopmental and Related Disabilities (LEND):
Fellows participate in Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program in which they acquire and apply knowledge of 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 develop 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 and the LEND curriculum can be found on the EK Shriver Center LEND Program Web site.
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 Medical Center at Tufts Medical Center and Tufts University School of Medicine. We participate in multiple teaching programs, including in the medical school, Physician Assistant Program, and dental school. All pediatric residents rotate at the CCSN (one month each in their first year). Family medicine, child neurology, child psychiatry and trainees from a broad range of disciplines also spend time at the CCSN. Fellows are an integral part of our teaching program and are expected to participate in the clinical precepting and seminar presentations we provide.
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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.
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. Throughout her residency, Dr. Stec enjoyed caring for children from immigrant and underserved communities and educating their families about various healthcare topics. Originally from Poland, Dr. Stec realized the need for a Developmental Behavioral Pediatrician that can cater to Chicago’s large Polish population. Thus, upon completion of 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 include learning more about the experiences of families of children newly diagnosed with autism during the COVID-19 pandemic and identifying common beliefs, barriers, and facilitators to care among these families.
Cristina Bird Collado, MD 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. Deanna Lau, DO 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.
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.
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.
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.
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)
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.
Levy, S, Hill, E, McKay, K, Sheldrick RC, Perrin EC. Co-located mental health/developmental care. Clinical Pediatrics, 56 (11): 1023-1031, 2017
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.
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.
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
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.
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.
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.
The fellowship accepts applications through ERAS. Selection is through the National Resident Matching Program.
For further information about Developmental-Behavioral Pediatrics Fellowship:
Nicole Hernandez Pediatric Fellowship Coordinator Tufts Medical Center at Tufts Medical Center nhernandez1@tuftsmedicalcenter.org
