Residency + Training Experiences

Welcome to the Developmental Behavioral Pediatrics rotation at the Center for Children with Special Needs Floating Hospital for Children @Tufts Medical Center!  We are very pleased to have you with us.

The Center for Children with Special Needs prides itself on delivering interdisciplinary services that are child- and family-centered. The assessments that we conduct are comprehensive and evaluate the “whole child” with an appreciation of the child’s strengths and weaknesses and an understanding of the child’s role and functioning within his/her family, peer group, school and community. The CCSN offers clinical care and advocacy for children who have developmental, behavioral, and emotional issues that interfere with their growth, learning, and family or social functioning.

Detailed information concerning your experience can be found on the Floating Residency website for the Pediatrics Residents.  For the Family Practice Residents, information for your elective can be found on your program website in the DBP folder. 

Why Developmental-Behavioral Pediatrics?

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 the Floating.  In addition to clinics and evaluations within the CCSN, there are several activities that take place outside of the Floating Hospital.  
                                                              

Weekly Schedule: 


Monday

Tuesday

Wednesday

Thursday

Friday

AM

0-6 year Clinic

1st week:
Observation

2nd week:
Patient Visit

3rd week:
Parent Feedback Visit

4th week:
Field Trip to TCC Day Care

Fellow’s Clinic

LEAP Clinic (School Age Clinic)

4th week:
Brookline School District with Dr. von Hahn



DBP Observation and/or Field Trip
Advocacy Rotation

PM

Observations and/or Field Trips, Self-Directed Learning (including report writing)

Observations and/or Field Trips, Self-Directed Learning (including report writing)

Noon-3:30 pm:
Grand Rounds and Didactic lecture blocks


Observations & Field Trips, Self-Directed Learning (including report writing)

Advocacy Rotation


An individualized schedule is discussed with the resident at the time of orientation at the start of rotation based upon observation schedule with clinical faculty and the residents’ cross-coverage and clinic schedules.

Goals and Objectives

There are three components to a resident’s experience in Developmental-Behavioral Pediatrics. The first is the 4 week PLI Core Rotation in Developmental Disabilities. The second is the Maternal Infant Unit teaching experience in New born Attachment. The third is the three year longitudinal experience comprised of 9 lectures and mentorship groups during the Wednesday afternoon didactic lecture series. 

1. PLI Core 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 

Attention Deficit/Hyperactivity Disorder. Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with ADHD and co-morbid disorders.

  • Use history and observation to identify preschool and school age children with problems of inattention, hyperactivity, and impulsivity.
  • Know the DSM V criteria for ADHD
  • Generate a differential diagnosis for ADHD and understand the importance of important co-morbidities (learning disabilities, oppositional defiant disorder, anxiety and depression, etc)
  • Understand the importance of and how to interpret parent and teacher screening questionnaires (Vanderbilt Assessment).
  • Be familiar with appropriate long term management approaches (pharmacotherapy, behavioral interventions) and the components of an effective educational program for children with ADHD (504 plan and IEP).

Developmental consequences of prematurity.

  • Recognize the spectrum of behavioral, cognitive, and motor outcomes associated with prematurity
  • Define the diagnosis and management of a young child and adolescent with cerebral palsy

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

Understand key components of a comprehensive developmental-behavioral history and conduct a thorough physical and dysmorphology exam

Observe or use standardized assessment tools as appropriate

Formulate a differential diagnosis

Demonstrate effective, compassionate, and culturally sensitive communication with the patient and family to assure patient and family understanding, mutual decision making, and the development of a management plan

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  
2. Mother Infant Unit Didactic Experience in Understanding and Communicating Infant Attachment to families

3. Goals and Objectives for the 3 year Longitudinal Experience in Normal Child Development and Behavior:

Identify age appropriate developmental and behavioral milestones for infants, children, adolescents:

  • Cognitive skills
  • Fine and gross motor skills
  • Receptive and expressive language
  • Social/emotional development
  • Self-help and adaptive behaviors
Recognize major theories of child development and apply this knowledge in the clinical setting to appreciate the spectrum of typical child development.

Recognize the role and limitations of developmental surveillance and screening in primary care practice

Apply and utilize the American Academy of Pediatrics algorithm for developmental surveillance and screening

Review the American Academy of Pediatrics Guidelines on effective parenting

Appreciate the role of psychosocial stressors (e.g., poverty, divorce, trauma) on child development

Recognize the role of a primary care provider role in discussing difficult childhood and adolescent behaviors including:

  • Sleep disturbance
  • Aggression
  • Toilet training
  • Masturbation
  • Separation anxiety and school refusal

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:


Monday

Tuesday

Wednesday

Thursday

Friday

Week 1


AM

7:30 am-12:30 pm 
Early Childhood Clinic

8 am-Noon

Fellows Follow Up Clinic

7:30 am-Noon

LEAP Clinic


Tri-City Early Intervention (Malden, MA) Family Medicine Continuity Clinic

PM

1-4 pm

Newborn Follow-up Clinic

Independent Study

Noon-3:30 pm

Pediatric GR and resident didactic
Independent Study Family Medicine Continuity Clinic
Week 2

         
 AM 8 am-Noon

Woburn Satellite Clinic (von Hahn)

Transportation Children Center (Boston, MA)  
7:30 am-Noon

LEAP Clinic


Independent Study
Family Medicine Continuity Clinic
 PM  

1-5 pm

Woburn Satellite Clinic (von Hahn)

Independent Study  

Noon-3:30 pm

Pediatric GR and resident didactic

Exit Interview (Ultmann) Family Medicine Continuity Clinic

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 

Attention Deficit/Hyperactivity Disorder. Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with ADHD and co-morbid disorders.

  • Use history and observation to identify preschool and school age children with problems of inattention, hyperactivity, and impulsivity.
  • Know the DSM V criteria for ADHD
  • Generate a differential diagnosis for ADHD and understand the importance of important co-morbidities (learning disabilities, oppositional defiant disorder, anxiety and depression, etc)
  • Understand the importance of and how to interpret parent and teacher screening questionnaires (Vanderbilt Assessment).
  • Be familiar with appropriate long term management approaches (pharmacotherapy, behavioral interventions) and the components of an effective educational program for children with ADHD (504 plan and IEP).

Developmental consequences of prematurity.

  • Recognize the spectrum of behavioral, cognitive, and motor outcomes associated with prematurity
  • Define the diagnosis and management of a young child and adolescent with cerebral palsy
Review available information from parents, early intervention programs, schools, community agencies, and prior medical consultations to inform diagnosis and management

Understand key components of a comprehensive developmental-behavioral history and conduct a thorough physical and dysmorphology exam

Observe or use standardized assessment tools as appropriate

Formulate a differential diagnosis

Demonstrate effective, compassionate, and culturally sensitive communication with the patient and family to assure patient and family understanding, mutual decision making, and the development of a management plan

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