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|Developmental and Behavioral Pediatrics | |

|**All Goals and Objectives for this rotation are identical across all PL years** | |

|Primary Goals for this Rotation |  Competencies |

|GOAL I: Prevention (Dev-Beh). Understand the role of the pediatrician in the prevention of developmental and behavioral problems in |  |

|children. | |

|Describe the common prenatal influences that impair typical development. | K |

|Describe the common postnatal influences that impair typical development. | K |

|Describe the common environmental, social and family influences that promote optimal development and behavior of a child. | K, SBP |

|Describe the common environmental, social and family influences that interfere with the typical development and behavior of a child. | K,SBP |

|Refer patients at risk to appropriate early intervention services and specialists. | K,P,IPC, SBP |

|Advocate for patients with special developmental, behavioral, and educational needs. | PC, P, SBP, |

| |IPC |

|GOAL II: Normal vs. Abnormal (Dev-Beh). Develop a working knowledge of typical development and behavior for children and families and |  |

|apply this knowledge in the clinical setting to differentiate normal from abnormal states. | |

|For each of the domains of child development: | K |

|Describe the spectrum of age-appropriate development and variations from typical for children from birth through adolescence. | K |

|Identify major theories of development. | K |

|Discuss how different developmental domains interact and influence one another at different stages of development. | K |

|Counsel families on the variations within typical development. | K, IPC |

|Identify "red flags" of abnormal development. | K |

|Describe a child's typical progress in each of the following developmental domains, identify signs of abnormal development, and provide | K, IPC |

|parents with counseling concerning: | |

|Cognitive skills | |

|Fine and gross motor skills | |

|Receptive and expressive language | |

|Social/emotional development | |

|Self-help and adaptive behaviors | |

|For the common domains of child behavior: |  |

|Describe the spectrum of age-appropriate development and variations from typical for children from birth through adolescence. | K |

|Identify major theories of behavioral development. | K |

|Discuss how different developmental and behavioral domains interact and influence one another at different stages. | K |

|Counsel families on the variations within typical behavior. | K, IPC |

|Diagnose "red flags" of abnormal behavior. | K, PC |

|Describe a child's typical progress in each of the following behavioral domains, identify signs of abnormal development, and provide | K,PC, IPC, P |

|parents with counseling concerning: | |

|Attachment (bonding) | |

|Autonomy | |

|Elimination | |

|Eating | |

|Sexuality | |

|Sleep | |

|Temperament | |

|Counsel parents about typical parenting issues (related to child development, behavior, health and safety, family adjustment). | K, IPC |

|Diagnose and manage specific pediatric behavioral, developmental and medical problems using knowledge and insight about family development| K, PC, IPC |

|and family systems theory. | |

|Recognize and differentiate between developmentally-appropriate coping strategies used by children and their families to contend with | K |

|illness and medical interventions, and common ineffective coping strategies, including non-compliance. | |

|Use standardized, validated and accurate developmental and behavioral screening instruments, plus skills in interview, exam and medical | K, PC |

|knowledge to identify patterns of atypical development, such as: | |

|ADHD home and school questionnaires (e.g., Vanderbilt, Connors) | |

|Behavioral screening questionnaire (e.g., Eyberg Child Behavior Inventory, Pediatric Symptom Check List, PEDS, ASQ-SE) | |

|Developmental screening tools reliant on parental report (e.g., ASQ, PEDS, CDIs) | |

|Developmental screening tools requiring direct elicitation and measurement of children's behavior (e.g. Brigance, Battelle, Bayley Infant | |

|Neurodevelopmental Screener, SWILS) | |

|Hearing screening (general, pure tone audiometry, otoacoustic emissions) | |

|Language screening | |

|Home and parent risk assessment tools to screen for social concerns, e.g., alcohol abuse, domestic violence, depression (e.g., Family | |

|Psychosocial Screen, Edinburgh Depression Inventory) | |

|Select, perform and/or interpret appropriate clinical tests to establish a medical etiology of identified developmental and/or behavioral | K, PC |

|problems, such as: | |

|Blood tests to rule out organic or genetic conditions (such as thyroid function, lead screen, genetic testing, metabolic screening) | |

|Neuroimaging studies and others (such as head MRI) | |

|Demonstrate familiarity with commonly used clinical and psychoeducational testing used by specialists to evaluate and monitor children | K |

|with developmental and behavioral problems. | |

|Identify common measures of intelligence used with infants, preschool and school age children (e.g., WPPSI, WISC-III, K-ABC). | |

|Recognize common diagnostic measures of achievement, speech-language, and adaptive behavior (e.g., WRAT-R, Vineland Adaptive Behavior | |

|Scales, Preschool Language Scale-IV). | |

|Understand the meaning of quotients and percentiles, the range of possible scores, common averages and standard deviations. | |

|Know the scores typically observed in children with specific developmental conditions such as mental retardation, learning disabilities, | |

|giftedness, etc. | |

|GOAL III: Anticipatory Guidance (Dev-Beh). Provide appropriate anticipatory guidance related to common developmental and behavioral |  |

|issues. | |

|Provide anticipatory guidance to parents about expected behaviors or milestones at a child's next developmental level. | K, PC, IPC |

|Provide anticipatory guidance to families about developmental aspects of injury prevention, common behaviors (i.e., feeding), discipline, | K, PC, IPC |

|and child's approach to the physical exam and interview. | |

|Provide anticipatory guidance, developmental promotion, and counseling for the following issues and problems: |  |

|Adoption | K, PC, IPC, |

| |SBP |

|Children at risk due to poverty, abuse or neglect, etc. | K, PC, IPC, |

| |SBP |

|Behavioral management and positive disciplinary techniques | K, PC, IPC |

|Normal independence seeking and limit testing behaviors | K, PC, IPC |

|Positive attention | K, PC, IPC |

|Warnings and punishment | K, PC, IPC |

|Day care | K, PC, IPC |

|Death of a family member | K, PC, IPC |

|Developmental disabilities, including transition needs from infancy through adolescence and young adulthood | K, PC, IPC,SBP |

|Divorce | K, PC, IPC |

|Early intervention programs | K, PC, IPC, |

| |SBP |

|Eating problems | K, PC, IPC |

|Exposure to violence | K, PC, IPC |

|Gifted children | K, PC, IPC, |

| |SBP |

|Habits (thumb sucking and nail biting) | K, PC, IPC |

|Typical sleep patterns | K, PC, IPC |

|Parenting in a variety of settings, such as adoptive, foster, single parents, step or "blended" families, etc. | K, PC, IPC |

|Peer relationships and social skills | K, PC, IPC |

|Resiliency | K, PC, IPC |

|School success and failure | K, PC, IPC |

|Self-esteem | K, PC, IPC |

|Sexuality (typical patterns of sexual behavior, masturbation, sexual preference, sexually transmitted diseases, birth control) | K, PC, IPC |

|Sibling rivalry | K, PC, IPC |

|Sleep problems | K, PC, IPC |

|Substance abuse | K, PC, IPC, |

| |SBP |

|Television, video, computer and media | K, PC, IPC |

|Toilet training | K, PC, IPC |

|Preschool and kindergarten readiness | K, PC, IPC |

|Study skills and home work assistance | K, PC, IPC |

|Promoting speech and language development | K, PC, IPC |

|Literacy promotion | K, PC, IPC |

|Separation issues | K, PC, IPC |

|Bullying | K, PC, IPC |

|GOAL IV: Undifferentiated Signs and Symptoms (Dev-Beh). Evaluate and manage common developmental-behavioral signs and symptoms in infants,|  |

|children, and adolescents. | |

|For developmental-behavioral signs and symptoms in infants, children, and adolescents: |  |

|Perform an appropriate problem-oriented interview and physical examination. | K, PC, IPC |

|Obtain additional information from other related sources (e.g., day care, school). | K, PC, IPC |

|Formulate a differential diagnosis, including typical variants where appropriate. | K, PC |

|Use structured screening instruments as appropriate. | K, PC |

|Formulate and carry out a plan for evaluation. | K,PC |

|Develop a management plan with the patient and family. | K, PC, IPC |

|Demonstrate effective communication to insure accurate history-taking, patient and family understanding, mutual decision-making, and | I, PC, IPC |

|adherence to therapy. | |

|Provide appropriate follow-up, including case management, when multiple disciplines are involved. | K, PC, IPC, |

| |SBP |

|Evaluate and manage the following developmental-behavioral signs and symptoms, provide appropriate counseling to parents or patients, and | K, PC, IPC, |

|identify appropriate referral resources: |SBP |

|Inattention | |

|Hyperactivity | |

|Delay in a single developmental domain | |

|Delay in multiple developmental domains | |

|Sleep disturbances | |

|Elimination disturbances | |

|Feeding disturbances | |

|Poor academic performance | |

|Loss of developmental milestones | |

|Regression of behavioral self-control | |

|Excessive out-of-control behaviors (e.g., anger outbursts) | |

|Abrupt change in eating, sleeping, and/or socialization | |

|Anxiety | |

|Depressed affect | |

|Grief | |

|Sexual orientation issues | |

|Gender identity issues | |

|Somatic complaints | |

|Obsessive-compulsive symptoms | |

|Separation anxiety | |

|Tics | |

|Somatic complaints | |

|Violence | |

|Excessive concerns about body image | |

|GOAL V: Common Conditions Not Referred (Dev-Beh). Recognize and manage common developmental and behavioral conditions that generally do |  |

|not require referral. | |

|For the common developmental-behavioral problems commonly observed in infants, children, and adolescents: |  |

|Describe diagnostic criteria, applying DSM-PC codes that determine variation, problem, or condition. | K |

|Discuss environmental and biologic risk factors. | K |

|Explain alternative or co-morbid conditions. | K |

|Describe natural history and common variations. | K |

|Implement assessment appropriate to the primary care setting, including input from home, school and other environments as necessary. | K, PC, IPC, |

| |SBP |

|Implement individualized case management. | K, PC, SBP |

|Counsel parents in age-appropriate intervention. | K, PC, IPC |

|Describe indications for referral to other professionals for evaluation or treatment. | K, PC |

|Execute appropriate referrals to mental health and other professionals and other community resources. | K, PC, IPC, |

| |SBP |

|Recognize and manage, and counsel parents and patients concerning the following common developmental and behavioral problems that do not | K, PC, IPC |

|generally require referral: | |

|Adjustment reactions | |

|Attention deficit hyperactivity disorder, uncomplicated | |

|Breath-holding spells | |

|Physiologic crying in infancy and colic | |

|Oppositional behavior | |

|Difficulties with parenting and discipline | |

|Encopresis | |

|Enuresis | |

|Failure to thrive | |

|Fears and anxiety | |

|Habits (nail biting, hair twirling, etc.) | |

|School avoidance/refusal | |

|Sleep-wake cycle disturbances | |

|Stress reactions | |

|Temper tantrums | |

|Head banging | |

|Simple motor tic | |

|Typical separation anxiety | |

|Functional pain | |

|Mild depression | |

|GOAL VI: Common Conditions Generally Referred (Dev-Beh). Recognize, provide initial management, appropriately refer, and provide primary |  |

|care case management for common developmental or behavioral conditions that often need additional diagnostic and/or management support | |

|from other specialties or disciplines. | |

|For the more complex developmental-behavioral problems that require referral for diagnostic or management support: | K, PC, IPC, |

|Describe diagnostic criteria. |SBP |

|Discuss environmental and biologic risk factors. | |

|Identify alternative or co-morbid conditions. | |

|Describe natural history. | |

|Organize initial assessment, consultation, and ongoing management as the primary care pediatrician. | |

|Recognize, provide initial management, appropriately refer and provide primary care case management for the following | K, PC, IPC, |

|developmental-behavioral conditions: |SBP |

|Developmental-behavioral disorders associated with chronic physical health conditions (e.g., spina bifida, cleft lip, cleft palate, | |

|paraplegia, amputation, sensory impairment, Tourette's disorder, prematurity) | |

|Cognitive disabilities (e.g., mental retardation) | |

|Language and learning disabilities | |

|Motor disabilities (e.g., cerebral palsy, muscular dystrophy) | |

|Autistic spectrum disorders | |

|Attention problems, moderate to severe | |

|Externalizing disorders (e.g., violence, conduct disorder, antisocial behavior, oppositional defiant disorder, school failure, school | |

|phobia, excessive school absences, firesetting) | |

|Internalizing disorders (e.g., adjustment disorder, anxiety disorder, conversion reactions, somatoform disorders, depression, mood | |

|disorders, suicide contemplation or attempt, PTSD) | |

|Substance abuse | |

|Social and environmental morbidities (e.g., physical abuse, sexual abuse, parental health disorders such as depression and substance | |

|abuse) | |

|Problems of feeding, eating, elimination, sleep | |

|Atypical behaviors (e.g., post traumatic stress disorder, psychosis) | |

|Problems of gender identity, sexuality, or related issues | |

|Psychosis/Schizophrenia, borderline personality | |

|Serve as case manager or active team participant for individuals with developmental and behavioral disorders through the primary care |  |

|setting, demonstrating skills including, but not limited to: | |

|Communication and record-sharing with other disciplines | IPC, P |

|Maintenance of a complete problem list | K, PC, IPC |

|Managing the "whole patient" | K, PC, P |

|Family empowerment and communication | K, PC, IPC, P |

|Maintain patient and family confidentiality (HIPAA) |PC, IPC, P |

|Discuss interventions and specialists that assist with the diagnosis or ongoing management of children with developmental-behavioral | K, PC, IPC, P, SBP |

|disorders, demonstrate knowledge of referral sources, and demonstrate ability to work collaboratively with a variety of these | |

|professionals. | |

|Audiologist | |

|Behavior modification specialists | |

|Child Life | |

|Child psychiatry | |

|Child psychology | |

|Community resources/support systems (Boys and Girls club, Family Resource Centers) | |

|Developmental-behavioral pediatrician | |

|Early intervention services | |

|Educational intervention (preschool and school age) | |

|Family counseling | |

|Feeding specialists | |

|Hypnosis, relaxation, and self-control techniques | |

|Interdisciplinary team for evaluation | |

|Neurodevelopmental pediatrician | |

|Pediatric neurology | |

|Occupational therapy | |

|Physical therapy | |

|Physical medicine and rehabilitation | |

|Pharmacotherapy | |

|Social work services | |

|Speech and language therapy | |

|Teachers | |

|Vision specialist | |

|Other (play therapy, music therapy, support groups, parent training, etc.) | |

|Procedures |  |

|GOAL VII: Diagnostic and screening procedures. Describe the following tests or procedures, including how they work and when they should be|  |

|used; competently perform those commonly used by the pediatrician in practice. | |

|ADHD home and school questionnaires | K, PC |

|Audiometry evaluation: interpretation | K, PC |

|Behavioral screening questionnaire | K, PC |

|Developmental screening test | K, PC |

|Hearing screening | K, PC |

|Language screening test | K, PC |

|Vision screening | K, PC |

Core Competencies:

K - Medical Knowledge

PC - Patient Care

IPC - Interpersonal and Communication Skills

P - Professionalism

PBLI -Practice-Based Learning and Improvement

SBP - Systems-Based Practice

Performance Expectations by Level of Training

| |Beginning |Developing |Accomplished |Competent |

| |Description of identifiable |Description of identifiable |Description of identifiable |Description of identifiable |

| |performance characteristics |performance characteristics |performance characteristics |performance characteristics |

| |reflecting a beginning level |reflecting development and |reflecting near mastery of |reflecting the highest level of |

| |of performance. |movement toward mastery of |performance. |performance. |

| | |performance. | | |

|Medical Knowledge |PL1 |PL1, PL2 |PL2, PL3 |PL3 |

|Patient Care |PL1 |PL1, PL2 |PL2, PL3 |PL3 |

|Interpersonal and |PL1 |PL1, PL2 |PL2, PL3 |PL3 |

|Communication Skills | | | | |

|Professionalism | |PL1 |PL2, PL3 |PL3 |

|Practice-Based Learning |PL1 |PL1, PL2 |PL2, PL3 |PL3 |

|and Improvement | | | | |

|Systems-Based Practice |PL1 |PL1, PL2 |PL2, PL3 |PL3 |

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