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Guidelines for Training in Developmental and Behavioral Pediatrics

Introduction

Developmental and Behavioral Pediatrics is now an established pediatric subspecialty in many medical
centers across the world. The discipline was initially devoted to cataloguing the various behavioural and
neurodevelopmental disorders that affect the children and adolescents. It now comprises an extensive
knowledge of pathophysiology, numerous diagnostic options, and therapeutic interventions that
contribute to the clinical care of infants, children, adolescents (pediatric patients) and even young adults
with behavioural, socioemotional and developmental disabilities. Acquisition of specific observational
skills and knowledge is essential for the subspecialist to practice Developmental and Behavioral
Pediatrics.

Recently, the emergence of the Philippine Society of Developmental and Behavioral Pediatrics ( PSDBP)
was recognized by the Philippine Pediatric Society as a pediatric subspecialty society with members
requiring completion of a 2 or 3 year fellowship and successful passage of a Sub-Board examination in
Developmental Pediatrics to be certified as a subspecialist.

Historically, individual training directors (i.e. Philippine General Hospital and Philippine Childrens
Medical Center) determined the structure of their respective training programs, including the body of
knowledge and technical skills required for graduation. Not surprisingly, graduation requirements vary
greatly at present. It is the purpose of this document to define the core body of knowledge and
technical skills that must be acquired by all developmental paediatrician trainees to assure that the care
of pediatric patients with developmental and behavioural disorders is of the highest quality. The
investment in training experts in developmental pediatrics and the special skills required to practice this
subspeciality will be under increasing scrutiny as economic issues drive decisions in patient care and as
practitioners with insufficient training compete to care for pediatric patients. Accessibility to competent
developmental paediatricians is essential in the current economic and managed medical care
environment. Therefore, a Core Curriculum in Developmental Pediatrics has been drawn up to define
the skills and knowledge required of a developmental paediatrician and will be of benefit to
accreditation by a council for a graduate medical education in the future .

Although the minimum skills and knowledge required to diagnose and manage neurodevelopmental and
behavioral disorders affecting pediatric patients are defined, individual programs vary according to
differences in the career goals of trainees. Two years of fellowship training are currently mandated, but
a longer period may be required to acquire skills and knowledge in areas of specialization such as
transition to young adulthood care, certain techniques for autism diagnosis , nutrition for the disabled,
medical home concept and practice and hypothesis-based research.

The primary care physician is equally involved in the early detection and management of developmental
disabilities and as a partner in this endeavour, the basic requirements of a pediatric resident have been
included in this core curriculum guide. The following document therefore includes basic requirements in
the training of residents and fellows.

Developmental and Behavioral Studies Unit

Section of DevelopmentalPediatrics
Department of Pediatrics
Philippine General Hospital
2012
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Training for Residents

Clinical rotation of pediatric residents at the Section of Developmental and Behavioral Pediatrics

DESCRIPTION OF THE COURSE:

This rotation deals with the principles of screening, early detection and diagnosis , and basic
management of common developmental and behavioral conditions. This will enable the pediatric
resident to acquire the necessary knowledge, skills and attitude that will help them address primary and
secondary health care, family concerns and other issues of this unique population .

One to two pediatric residents will be rotating at the Section of Developmental and Behavioral
Pediatrics for a MINIMUM of one month.

GENERAL OBJECTIVE:

At the end of the rotation, the resident should understand the basic principles in the approach,
assessment and management of a child who needs ambulatory care on a continuing basis in the context
of using good observations techniques , adequate and comprehensive family interview and the accurate
administration of at least one standardized developmental instrument.

SPECIFIC OBJECTIVES:

At the end of the rotation, the resident must:

1. Demonstrate proper knowledge, skills and attitude in approaching pediatric patients seen at the
developmental and behavioral clinic.
2. Efficiently screen patients at risk for developmental problems using the PEDS or Denver.
3. Demonstrate effective communication techniques and counseling to patients.
4. Define the components of screening and surveillance which includes anticipatory guidance,
diagnostic interventions, school placement and therapeutic management.
5. Make appropriate referrals to other health professionals and community resources under the
supervision of the developmental pediatrics fellow in charge.
6. Develop a health care plan for the cases seen at the out patient clinic.

TOPICS:
Topics Sources
1. Normal Theoretical Framework and Nelsons, 18th ed.
Development Foundations of Normal Capute, Vol.1, Chapter1
Development Carey and Crocker, Chapter 2

2. Screening and Use of the following tests in the AAP Screening and Surveillance
Surveillance screening and early assessment Algorithm
of development and behavior: Pediatrics
PEDS
Developmental and Behavioral Studies Unit
Section of DevelopmentalPediatrics
Department of Pediatrics
Philippine General Hospital
2012
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M-CHAT
Denver II
Pediatric Symptom Checklist

Red Flag signs of development

3. Common Out Patient Clinical signs and symptoms of Capute Vol.1
Developmental and the following: Dworkin, Chapter 14, 15, 16
Behavioral problems Global Developmental Delay Capute, Vol.1
Problems in the different ADHD
age groups Mental Retardation
Motor disabilities (Cerebral
Palsy)
Autism
3. Treatment and The Interdisciplinary Team Carey and Crocker, Chapter 8
Management Approach
Family Centered care and the
Medical Home
Evidence based psychological
and pharmacological
management of the different
disorders

Responsibilities of the Resident Rotator

1. To attend all outpatient clinics , didactic sessions and community outreach programs of the Section.

2. To handle new patients by taking a complete history, doing a thorough physical and neurological
examination, assessing the patients developmental profiles using the available screening tools ,
completing behavioural observations, formulating a provisional diagnosis and and making the
necessary recommendations for management under the supervision of the developmental fellow in
charge

3. To assist the developmental fellow in the management of all follow-up patients

4. To accomplish all forms pertinent to each patient

PEDS/ Denver II of patients requesting for scheduling
data collection forms
follow-up forms
growth curves
referral letters (CAMP, schools, etc)
lab requests

5. To accomplish the patient registry and monthly census

Developmental and Behavioral Studies Unit

Section of DevelopmentalPediatrics
Department of Pediatrics
Philippine General Hospital
2012
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Requirements

Requirement Minimum
Number

1. Administration and Scoring of the PEDS 5 patients

2. Completing a full history ( emphasis on developmental 5 patients

and behavioural )and physical examination ( emphasis
on mental status and behavioural observations) on
every new patient with a preliminary clinical diagnosis
3. Administration of a developmental tool and co-
management under the with fellows supervision of:
( Any two of the following)
a. Global Developmental Delay or 1 patient
Mental Retardation

b. Autism 1 patient

c. Cerebral Palsy 1 patient

d. ADHD 1 patient

2. Presentation of cases/journals 1 presentation

(case protocol to be submitted ahead of any of the
above cases seen and managed)

5. Special Project ( for a group of residents) 1 project

6. End of Rotation Written Exam

Mechanics:

1. The resident has to administer the PEDS on at least 5 patients who are seeking an appointment
at the Developmental Clinic. Parents are asked to answer the PEDS. The resident scores and
interprets the PEDS and gives necessary requests for any investigation.

2. At the end of the rotation, the resident will have completed at least 2 charts of children with the
abovementioned condition.

3. If a group of residents are rotating at the same time in the section, they will be asked to submit
a group project assigned to them by the chief fellow of the section. Examples of projects are
videos of developmental milestones, parent education materials, student-teaching materials.

Developmental and Behavioral Studies Unit

Section of DevelopmentalPediatrics
Department of Pediatrics
Philippine General Hospital
2012
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Developmental and Behavioral Studies Unit

Section of DevelopmentalPediatrics
Department of Pediatrics
Philippine General Hospital
2012