1 - Stony Brook Medicine
| | |
|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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