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Fellowship

Fellowship Program

Developmental Behavioral Pediatrics Program - DBP

Curriculum

a)   Biological mechanisms of behavior and development, e.g., development and functional organization of the central nervous system, genetics, and biological risk factors.

The DBP fellow will learn about the biological mechanisms of behavior and development through the didactic sessions at the Institute for the Study of Child Development (Brown Bag Series) in all three years, and also through attending outpatient counseling sessions  at Childrens Specialized Hospital.

b)   Family and social/cultural factors that contribute to children’s development and family functioning

As a part of the developmental behavioral clinics, ADHD clinics and Autism clinics in all three years, there will be participation with social workers, nurses and nurse practitioners as they obtain initial intake of family history, and social history. Cultural factors are explored through the same clinics, especially while formulating treatment options.

c)   Variations in temperament and adaptive styles

Infant and child temperament and adaptive styles are reviewed extensively through the Institute for the Study of Child Development by way of their regular seminars, and are also covered by the Attendings while reviewing the differential diagnosis of ADHD and other behavioral disorders.

d)   Adaptations to general health problems and their treatments, e.g., acute illnesses, chronic illnesses, physical disabilities, Hospitalization

Adaptations to general health problems and their treatments are covered in the subspecialty clinics, where children with a variety of conditions are seen, including children with HIV, sickle cell disease, arthritis and other chronic illnesses. These are also reviewed during inpatient consultations done for hospitalized children.

e)   Developmental and behavioral aspects of a wide variety of childhood conditions, e.g., perinatal conditions, chromosomal/genetic disorders, metabolic, neurologic, sensory, endocrine, cardiac disorders, etc.

The influence on the development and behavior of children of perinatal risk factors, genetic disorders, metabolic conditions, neurologic disorders, and hearing and vision impairments, including prematurity are covered in the neonatal follow up clinic, genetics clinic, neurology clinics, and developmental behavioral clinics. These topics are also covered via journal clubs, lectures by faculty and outside speakers.

f)   Cognitive disabilities

Children with cognitive disabilities are seen in the developmental behavioral clinics, autism clinics, and traumatic brain injury unit. These topics are also covered during grand rounds and interdisciplinary conferences.

g)   Language and learning disorders

The fellow will learn about language and learning disorders through the developmental behavioral clinics, autism clinics, and during speech language evaluation and treatment sessions. Rehab inservice presentations will cover these topics in a didactic manner.

h)   Motor disabilities, e.g., cerebral palsy, myelodysplasia, dystrophies

Chidren with motor disorders are seen in the cerebral palsy centers which fellows attend when they have a session with a physiatrist.  They also attend the spina bifida clinic when they are with a physiatrist. Such children will also be seen during rotations with physical therapists and occupational therapists (rehab clinic), and orthopedic clinic. Lectures on cerebral palsy, muscular dystrophies, and meningomyelocele are included in the curriculum (rehab inservices).

i)    Autistic spectrum disorders, e.g., autism, Asperger

Experience with autistic spectrum disorders is obtained through the autism clinics, although many such children are also seen through the developmental behavioral clinics.  There are several didactic lectures on this topic included in the curriculum.

j)    Attention disorders

The fellow will see children with disorders of attention in the developmental behavioral clinics. They will have access to approved CME activities on this topic online, in addition to journal clubs, faculty lectures, and invited speakers.

k)   Externalizing conditions, e.g., aggressive behavior, conduct disorder, oppositional defiant disorder

Children with aggressive behaviors, conduct disorder, oppositional defiant disorder and other externalizing conditions are seen during sessions with psychiatrists and psychologists. These issues also come up in the developmental behavioral clinics. The curriculum includes specific lectures  on these topics.

l)    Internalizing behaviors, e.g., anxiety, mood, and obsessive disorders, suicidal behavior

Children with internalizing behaviors are also seen during sessions with psychiatrists and psychologists, although these issues surface in developmental behavioral clinics as well. These topics are covered in psychology inservice presentations as well as in the medical symposium series.

m)  Substance use/abuse, e.g., tobacco, alcohol, illicit drugs

The fellow will see children with substance abuse during sessions with the psychiatrists. This topic also gets covered during multidisciplinary case conferences with specialized schools.

n)   Child abuse and neglect, e.g., physical, sexual, factitious

Although there is no separate child abuse clinic, these children are seen through the developmental behavioral clinics, and a special effort has been made to include didactic lectures on this topic in the curriculum.

o)   Somatoform conditions

Children with somatoform conditions are seen during sessions with the psychiatrists and psychologists, and also through the adolescent clinic, which the fellow will attend as a part of the subspecialty rotation.

p)   Sleep problems

Children with sleep disorders are seen in the sleep clinic (part of the pulmonolgy portion of the subspecialty clinics). Sleep issues are also encountered and addressed extensively in all the developmental behavioral clinics, and autism clinics. There are lectures included in the curriculum on this topic.

q)   Feeding/eating difficulties, e.g., obesity, failure to thrive, anorexia, bulimia

Chidren with eating disorders are seen in the adolescent clinic, which is a part of the subspecialty clinic rotation. Children with failure to thrive are more likely to be seen in the developmental behavioral clinics, GI subspecialty clinic, and speech/feeding sessions. Didactic sessions on these topics are arranged through the rehab inservices.

r)    Elimination problems, e.g., encopresis, enuresis

Encopresis is addressed through developmental behavioral clinics, and GI clinic. Enuresis is addressed through developmental behavioral clinics, also pediatric urologists are available for consultation and discussion as needed.

s)   Variations and difficulties in sexual development, e.g., sexual orientation, gender identity, deviance

Children with sexual orientation and gender identity issues are seen through the adolescent clinic and psychiatry clinic.

t)    Atypical behaviors, e.g., tic disorders, self-injurious behavior, repetitive behaviors

Autism clinics, developmental behavioral clinics and neurology clinics provide extensive opportunities for the fellow to develop expertise in tic disorders, self injurious behaviors and stereotypic behaviors. Didactic lectures on these topics are included in the curriculum.

u)   Complementary and alternative therapies

Complementary and alternative treatments get reviewed at practically all clinic visits in all of the developmental behavioral, and autism clinics. There are review articles that have been included in the curriculum, in addition to web based CME activities on this topic.

v)   Law, ethics and advocacy

The issues of law, advocacy and ethics get reviewed extensively during multidisciplinary case conferences, telephone management at all clinics, and through the community based programs that the fellow attends (e.g. Early Intervention). There are several formal presentations throughout the year on these topics through the Boggs center.

w)  Medical education

The fellow will have ample opportunity to attend CME activities through seminars and meetings of the society for developmental behavioral pediatrics, in addition to web based CME activities.

x)   Research methods and statistics

There will be a dedicated block of time of 6 months in the second half of the 1st year, and 6 months in the first half of the 2nd year, dedicated to research and scholarly activities, for a total of 12 months. During this time, research methods and statistics will be taught, at the Institute for the Study of Child Development .  There are didactic sessions scheduled through the Institute for the Study of Child Development and the division of Neonatology on these topics.