Developmental Pediatrics

Introduction

A sound understanding of normal and abnormal child development is essential for the practicing pediatric neurologist.  Though developmental pediatricians are usually responsible for the diagnosis and management of primary developmental disorders, children with developmental delay and related diagnoses are seen exceedingly frequently in the pediatric neurology setting and therefore knowledge of these diagnoses and their management is essential.  This outpatient experience allows the trainee to witness evaluations for developmental disorders and the subsequent management/counseling of patients diagnosed with them.

Schedule

Scheduling is arranged by the Developmental pediatrics administrative assistants.  A formal schedule is assigned prior to the beginning of the rotation along with rotation goals and objectives.  The rotation is composed of an array of outpatient experiences including Down syndrome clinic, Autism and Developmental disabilities clinic, ADHD clinic, Cerebral Palsy clinic, Newborn follow up clinic, among others.  Formal didactics are also scheduled during this 4 week long experience.

Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological, and social behavioral knowledge needed by a child neurologist; demonstrate the ability to acquire, critically interpret and apply this knowledge in patient care.

1. Normal developmental milestones from 0-6 years
   1. Describe normal developmental milestones from 0-6 years in primary domains of development, including language, cognitive, motor, and social/emotional development
2. Screening for developmental and behavior problems
   1. List developmental screening schedule and appropriate screening tests that pediatricians use for identification of developmental and behavioral problems in early childhood.
3. Developmental delay
   1. Describe the diagnostic criteria of common developmental diagnoses, including global developmental delay, autism spectrum disorder, cerebral palsy, intellectual disability, and ADHD
   2. Describe the initial medical and neurologic evaluation for a child who is diagnosed with global developmental delay/intellectual disability
   3. Describe the initial medical and neurologic evaluation for a child who diagnosed with autism spectrum disorder
4. Educational and behavioral treatment
   1. Demonstrate skill in identifying when referral for therapy and educational services is indicated
   2. Describe the major features of positive parenting and demonstrate skill in counseling families about the basics of behavior management
5. Psychopharmacology
   1. Identify the different classes of medications commonly used to treat developmental and behavioral conditions
   2. List the indications/contra-indications for each class
   3. Describe the appropriates guidelines for psychopharmacological treatment developmental and behavioral conditions

Patient Care

Provide family-centered patient care that is development- and age-appropriate, compassionate, and effective for the treatment of health problems and the promotion of health.

1. History and physical skills
   1. Demonstrate developmentally appropriate interview skills for children with varying developmental levels
   2. Demonstrate the ability to acquire a thorough developmental history
   3. Demonstrate developmentally appropriate physical exam skills for children with varying developmental levels
   4. Demonstrate the ability to assess risk factors for abuse/neglect and prenatal substance exposure in a respectful manner
   5. Demonstrate ability to assess a child’s social reciprocity and social interactions during a visit
2. Medical decision making
   1. Demonstrate ability to develop a focused differential diagnosis for developmental delays
   2. Demonstrate an awareness of the role of environmental expectations and supports (or lack thereof) in exacerbating or supporting developmental and behavioral concerns
3. Patient counseling
   1. Demonstrate supportive and empathic counseling methods for common developmental and behavioral concerns
   2. Demonstrate skill in identifying and referring to appropriate community based resources for children with developmental and behavioral concerns 

Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families, and professional associates.

1. Demonstrate effective and professional communication with other physicians and health care professionals on a multidisciplinary team
2. Demonstrate use of ‘people first’ language when talking about individuals with developmental disabilities
3. Demonstrate cultural competence by showing respect for patient’s and families beliefs, religion, ethnicity, and culture.
4. Demonstrate appropriate use of interpreters when needed
5. Demonstrate empathic and supportive counseling skills when discussing difficult news with families and patients

Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

1. Demonstrate reliability, responsibility, and respect for patients and families, including appropriate verbal and nonverbal communication
2. Work collaboratively and cooperatively as a member of a health care team, demonstrating a commitment to professional behavior in interactions with staff and professional colleagues.
3. Demonstrate respect for the knowledge and expertise of other members of the multidisciplinary team
4. Arrive on time for scheduled activities and appointments.
5. Demonstrate a commitment to professional responsibilities, even during periods of stress, by making a personal commitment to a respectful workplace, working collaboratively with other members of the health care team, engaging in self-assessment, and accepting external scrutiny to maintain professional standards.
6. Adhere to ethical and legal principles.

Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

1. Critically review required articles on MedHub
2. Evaluate their own performance to identify gaps in knowledge base, and target self-directed learning to enhance performance.
3. Make evidence-based decisions in patient care by formulating pertinent clinical questions, retrieving and critically appraising relevant up-to-date information, and applying that information to inform clinical decisions.
4. Identify standardized guidelines for diagnosis and treatment of conditions common to developmental-behavioral pediatrics and adapt them to the individual needs of specific patients.
5. Demonstrate willingness to learn from error.
6. Provide, request, accept, and incorporate feedback.
7. Systematically organize relevant information resources for future reference, and plan for continuing acquisition of knowledge and skills. 

Systems-Based Practice

Understand how to practice high-quality health care and advocate for patients within the context of the health care system.

1. Identify key aspects of health care systems as they apply to developmental-behavioral pediatrics, including the referral process.
2. Take steps to avoid medical errors by recognizing the limits of one’s knowledge and expertise; work with the health care team to recognize and address systems errors.
3. Demonstrate sensitivity to the costs of clinical care in developmental-behavioral pediatrics, and take steps to minimize costs without compromising quality.
4. Understand the value of appropriate use of laboratory and radiographic testing, as well as their limitations.
5. Recognize and advocate for families who need assistance to deal with systems complexities, such as the referral process, lack of insurance, multiple medication refills, multiple appointments with long transport times, or inconvenient hours of service.
6. Identify appropriate community resources to support children with developmental disabilities and their families
7. Demonstrate an understanding of the need for partnership with a child’s school district in supporting their developmental and behavioral needs