Developmental and Behavioral Pediatrics Fellowship

1. To train fellows to provide patient care that is compassionate and effective for children with developmental/behavioral problems.The fellow will be taught to diagnose and manage children with developmental/behavioral issues resulting from chronic illnesses, cognitive/adaptive disabilities, language and learning disorders, motor disabilities, autism spectrum disorders, attention deficit hyperactivity disorder, externalizing behavioral conditions, internalizing behavioral conditions, substance use/abuse, child abuse and neglect, somatoform disorders and pain, sleep problems, feeding/eating problems, elimination disorders, atypical behaviors, and behaviors related to sexuality.
2. To help fellows acquire sound medical knowledge of the development of the central nervous system, the biological mechanisms of development and behavior and family and societal factors influencing development and behavior. The fellow will learn about normal milestones, normal behavioral patterns, the structure and functional diversity as well as socioeconomic diversities of various families, methods of screening children’s development and behavior as well as methods of diagnostic assessment, and specific treatments and interventions including medications, behavioral therapies, counseling and technological interventions. 
3. To teach fellows to critically review scientific evidence related to the various developmental behavioral conditions and to learn to use this knowledge for ongoing learning and for improving patient care.
4. To educate fellows about the systems of healthcare and resources in the community available to children and families with developmental/behavioral concerns, learn about the costs of evaluations and intervention, learn to evaluate the quality of patient care and learn to identify insufficiencies in healthcare delivery and ways of improving the inefficiencies.
5. To teach fellows compassion, integrity and respect for others, to demonstrate sensitivity towards various diverse cultures and to be accountable to patients, society and the profession. 
6. To train fellows in methods of effective interpersonal communication with patients and colleagues and other providers involved in the care of children with developmental/behavioral concerns.

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.

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.

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.

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.

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.

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.

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.

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

Children 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).

Autistic spectrum disorders, e.g., autism, Asperger's

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.

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.

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.

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.

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.

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.

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.

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.

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

Children 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.

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.

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.

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.

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.

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.

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.

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.

• Developmental Behavioral Clinics
• DBP Fellow Continuity Clinics
• Pediatric Medical & Surgical Subspecialty Clinics
• Neonatal High Risk Follow up Clinic
• Autism Clinics
• Rehab Clinics
• Interdisciplinary Clinics

• Core Lectures
• Journal Clubs
• Board Review sessions
• Bogg Center Developmental Disabilities Seminar Series
• Institute for the Study of Child Development Brown Bag Series
• Institute for the Study of Child Development Colloquium Series
• Rehab Therapy In-Service Series
• Pediatric Grand Rounds selected topics
• Pediatric Case Conference selected topics
• Research Lecture Series (through the Neonatology Division)
• Children’s Specialized Hospital Clinical Rounds

The fellow is given the opportunity to select a mentor from the program faculty. Time is allocated to meet with the mentor on a regular basis.

Lilian Mekhail, MD

Lilian Mekhail, MD, our first year fellow, came to us from a busy private practice in North Brunswick and joined our team in July 1, 2022. She is a board-certified pediatrician and an active member of the pediatric psychiatry collaborative including actively participating in QI projects aimed at increasing rates of use of routine screening tools in pediatrics in CRAFFT, PHQ9, PSC and PSC-Y. Dr. Mekhail also worked in the Southern Jersey Family Medical Centers in Pemberton, NJ from 2017 – 2021. She was voted NJ Favorite Kids Doc by NJ Family Magazine in 2019.  She led and coordinated Reach out and Read program with two sites from the FQHC aimed at incorporating the many benefits of reading into well child visits.

She graduated medical school from St. George’s University School of Medicine, Grenada in 2013 with honors.   She received her residency training at Goryeb Children’s Hospital-Atlantic Health System, Morristown, NJ where she graduated in 2016.  She is fluent in Arabic and English.

Odeilis Dominguez, MD

Odeilis Dominguez, MD, our third-year fellow, completed her Medical Degree from the Instituto Tecnológico de Santo Domingo (INTEC) Facultad de Ciencias de la Salud, Dominican Republic where she graduated in 2013 with academic honors.

As a volunteer she worked helping medical students from the United States in the Dominican Republic providing primary care free clinics in the community of Los Casabe. She guided medical students in the physical examination of patients, their diagnosis and treatment plans. Also delivered short lectures about the importance of vaccination. Among her notable scholarship awards, includes a French Immersion Course Scholarship from 2014-2015.  She came to the States and completed her Pediatric Residency at Lincoln Medical and Mental Health Center in New York in 2020. During that time, she participated in an ongoing PI project regarding failed hearing screen in the newborn and CMV results.

The training program in DBP at the Robert Wood Johnson Medical School is a collaborative program between the Robert Wood Johnson Medical School (includes the Child Health Institute of New Jersey and the Bristol Myers Squibb Children's Hospital) and Children’s Specialized Hospital (includes the New Brunswick, Mountainside, Toms River and other sites).

• Child Health Institute of New Jersey (CHINJ)
• Bristol Myers Squibb Children's Hospital (BMSCH)
• Children’s Specialized Hospital (CSH)

Overview

There will be a dedicated 12 month block rotation for research, spanning the latter 6 months of the 1st year and the first 6 months of the 2nd year. Fellows will be required to work towards completion of a project and a poster presentation or publication of the project.

The 1st year fellow will be responsible for meeting with the research director to plan and design a research project. They will be responsible for having in place a project for which data collection is already in progress.

The 2nd year fellow will be expected to work actively and diligently in pursuing the research project started in the 1st year. They are expected to have started exploring professional journals and society poster sessions in preparation for submitting their completed project. They are expected to be responsible for having a timeline for getting the project to the manuscript stage by the end of the 2nd year, although there will be time for final details during the 3rd year. They will attend Scholarly Oversight Committee meetings, and utilize the feedback during the meetings to improve upon and move their project forward.

The 3rd year fellow will be expected to finalize the research project started in the 1st year, if it has not been completed by the end of the 2nd year. They will be responsible for writing the manuscript under the guidance of the research director, and responsible for submitting the work to journals, or presenting the work at a professional society meeting. They will attend Scholarly Oversight Committee meetings not only for their own research project, but also the projects of the junior fellows, with the goal of sharing their accumulated research experience and expertise with the junior fellows.

Didactic Component

Didactic lectures are scheduled through the Institute for the Study of Child Development, and he Neonatology division.

Selection of Area of Research

This is done at the beginning of the 1st year, in conjunction with the research mentor.

Research Mentor

Dr. Michael Lewis, University Distinguished Professor, Director of the Institute for the Study of Child Development, serves as the research mentor.

Scholarship Oversight Committee (SOC)

The dept of Pediatrics has an SOC. Dr. Barry Weinberger from the division of Neonatology is the head of the SOC, and the other fellowship program directors often participate. For each specific fellow, the SOC is composed of 3-4 faculty with some research expertise in the fellow’s specialty, and at least one faculty outside of the specialty. The program director of the fellowship program recommends faculty to form an SOC committee for each fellow. The program director may serve as a mentor and participate in the SOC activities, but may not be a standing (i.e. voting) member of the SOC. The SOC meets 2-4 times per year, and makes sure that the Fellow stays on target with their research.

Project Completion

Ideally, should be done by the end of the research year, although there is time in the 3rd year, prior to completion of training, to finalize the research product.

Anna Malia Beckwith, MD
Program Director
Clinical Assistant Professor, Rutgers RWJMS

Matthew B. McDonald III MD
Chief Medical Officer
Children's Specialized Hospital

Michael Lewis, PhD
Research Director
University Distinguished Professor, Rutgers RWJMS
 
Manuel Jimenez, MD, MS
Assistant Professor
Pediatrics and Family Medicine and Community Health
Children's Specialized Hospital

Deborah Spitalnik, PhD
Professor, Rutgers RWJMS
Director of Advocacy Training

Tara Matthews, MD
Clinical Instructor, Rutgers RWJMS
Children’s Specialized Hospital

Lavinia Stoicescu, MD
Clinical Instructor

Inna Miroshnichenko, MD
Clinical Instructor
Children’s Specialized Hospital

Caroline Coffield, PhD
Assistant Professor, Rutgers RWJMS

Michael Dribbon, PhD
Psychologist
Vice President of Rehab Services

Jill Harris, PhD
Psychologist, Director of Psychology
Coordinator of Autism Services

Zeenat Q. Malik, MD
Clinical Assistant Professor,
Children's Specialized Hospital

• Ileana Bernal, MD - Child and Adolescent Psychiatrist
• Elvira Downs, MD - Child and Adolescent Psychiatrist
• Evelyn Traeger, MD- Pediatric Neurologist
• Vikram Bhise, MD- Pediatric Neurologist
• Diamond Martin, MD - Pediatric Physiatrist
• Michael Armento, MD - Pediatric Physiatrist
• Rugino Thomas, MD - Neurodevelopmental Pediatrician