Developmental and Behavioral Pediatric Education

Multimodal Online Resident Curriculum
Created by Drs. Anisha Srinivasan and Erika Phelps Nishiguchi
Developmental Behavioral Pediatrics Fellows
Created: April 2020
Last Updated: March 2021

Orientation Week

1. Gain a basic understanding of the field of Developmental-Behavioral Pediatrics (DBP)
2. Reflect on how you can promote child development in your own clinic and on a systemic level
3. Start to understand what DBPs do at UW and Seattle Children’s

• Individual Learning (Days 1-3)

  • DBP

    • **Introduction to Behavioral Pediatrics Video (~52 minutes)
    • **What is a DBP physician? Video (~35 minutes)
    • **Work-Up of Global Developmental Delay – Pediatrics Article 2014 by Moeschler (13 pages)
    • **Overview of the different DBP/NDV clinics at SCH and UW (3 pages)
    • **Browse profiles of those who make up the Division of Developmental Medicine
    • Developmental-Behavioral Pediatrics Observation Matrix – Over the course of your month rotation, take note of at least one observation of typical development (in continuity clinic, while you’re at the grocery store, on TV, in your home, etc) and at least one observation of delayed development per age level. For these children or for other observations, note parenting styles or reactions to child behaviors and reflect on whether they seemed appropriate for the behavior or not. Consider how you would respond respond to that behavior or parenting reaction in clinic. Take notes of resources that may be beneficial to you or your patients in the future. By the end of the rotation, be prepared to discuss this table with an attending or fellow.

  • Perspectives

    • **Watch See What Kids with Disabilities Can Do (~2.5 minutes)
    • **Watch Happiness in Children with Disabilities: What I’ve Learned as a Childhood Disability Doctor (10 min TEDx talk)

  • Theoretical Frameworks

    • **Watch CrashCourse Psychology: The Growth of Knowledge (~10 minutes)
    • **Read Overview of Child Developmental Theories

  • Off to the Races

    • **Work on Keystones of Development modules
    • **Watch Raising of America: early childhood and the future of our nation: Free online access through UW Libraries. 1st episode is a must watch, remaining 4 episodes are optional. Documentary explores how social conditions, public policies, systems level inequities affect child health and development.
      • To Access: https://alliance-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=CP71228081460001451&vid=UW&search_scope=all&tab=default_tab&lang=en_US&context=L
      • Trailer: https://www.raisingofamerica.org/

WEEK 1 OBJECTIVES (General Infant Development)

1. Understand typical infancy development milestones
2. Understand child temperament styles
3. Understand how to perform screening and surveillance for developmental delays
4. Understand the role of early intervention
5. Learn how to get help for developmental issues that arise in general pediatrics

• Individual Learning

  • Typical Development (Day 6)

    • **Baby Talk: 6-minute video on how speech develops in the first year presented by a speech pathologist
    • **CDC’s Milestones in Action: Photo & Video Library of typical milestones in all developmental domains
    • **Developmental Milestones: Peds in Review article. Has a nice chart of typical developmental milestones in all domains
    • **Guided Learning Session: Typical Child Development by Dr. Emily Myers

• • Atypical Development (Day 7)

    • **When & How to Screen for Developmental Delays (AAFP) — Article has good algorithms, visuals, and data on the sensitivity/specificity of different developmental screening tools (7 pages)
    • **Normal & Abnormal Neurological Exams: Birth to 30 months — View some video clips; keep in your toolkit as a reference for doing neurological exams
    • **Hammersmith Infant Neurological Exam — Review HINE PowerPoint presentation from UW Institute on Human Development and Disability’s Brooke Fitterer, PT, DPT, PCS and Sue Wendel, MS, OTR. Includes videos on how to perform HINE assessment.
    • **Navigating Your Way: Informing Families — Video on early intervention, how it works, when to refer, and other community resources (SSI, Within Reach, wraparound, etc) (~12 minutes)
    • **Early Intervention and the Role of the Pediatrician (Peds in Review): By our very own Lisa Herzig (9 pages!)
    • **Guided Learning Session: Early Intervention by Dr. Marnina Gottesman

• • Temperament (Day 8)

    • **Development of Attachment — 25 minute module on how attachment develops, institutionalized children, and early emotional bonding. Reading the transcripts rather than clicking through modules is fine
    • Temperament Topic of the Week — Review Mollie Grow’s TOW for a theoretical understanding of infant temperament types, and how to use this to discuss parent/infant compatibility
    • Optional Resources:
      • Attachment in Practice — 20-minute module on attachment behaviors and responding to infant cues
      • Temperament: A tool you can use for parents to identify their child’s temperament and their own temperaments to aid reflection and understanding
    • **Guided Learning Session: Temperament by Dr. Julia Mattson

• • Prematurity (Day 9)

    • **Neurodevelopmental Follow-Up of Preterm Infants (8 pages)
    • **Primary Care Developmental Follow-Up Framework for Preterm Infants (11 pages) 2023 AAP Article
    • **Watch 23 weeks and 6 days (~6 minutes)
    • Prematurity Pathway — Continuity clinic pathway for prematurity that was developed by a recently graduated resident, Sam Haley. One of the really impressive resident COVID projects (championed by our first group of residents on the DBP COVID-era curriculum) was creating several of these outpatient pathways to help streamline evidence-based care for common developmental and behavioral problems that show up in continuity clinic
    • Optional Resources:
      • Developmental and Interprofessional Care of the Preterm Infant Through NICU HRIF (5 pages)
      • Care of the NICU Graduate After Discharge
      • IVH and Neurodevelopmental Outcomes in Preterm Infants

• DBP Prep Questions: PREP Case-Based Questions
• (Optional) Movie Night:
  • Babies Documentary (Trailer): Need Amazon Prime account to view documentary (Video). Note: This is not the same as the new 2020 Netflix documentary, which goes into very interesting science but is several episodes. The Amazon documentary is 90 minutes and has no dialogue — just follows 4 babies as they grow into toddlers around the world.
• Weekly wrap-up with the fellows (1 hour): Goals — Time to reflect on learning of this week, ask questions, discuss cases.

WEEK 2 OBJECTIVES: (Toddler Development)

1. Know and understand different parenting styles
2. Learn the basics of difficult behavior management and resources for families
3. Understand speech, language, and communication acquisition and milestones
4. Understand socioemotional milestones and basics of autism
5. Learn about common disabilities seen in DBP

• Individual Learning

  • Parenting/Behavior Management (Days 12 & 13)

    • **Overview of the Four Parenting Styles — Brief overview of Baumrind’s 4 parenting styles (~2 pages)
    • **Cross-Cultural Perspectives on Parenting — Commentary by Drs. Erika Phelps Nishiguchi and Anisha Srinivasan (2 pages)
    • **TOW on Discipline: Good overview of parenting and discipline strategies promoted by the AAP

    • Interventions

      • Positive Parenting in a 15-minute Visit — Pediatrician John Duby discusses the ABC’s of behavior and how to counsel families in 15 minutes (~45 minute video)
      • Play Nicely — Interactive video on how to counsel parents on managing aggressive behaviors and effective discipline strategies. An evidence based program available in English and Spanish for free to parents
      • Choosing a Parent Training Program — Therapies available for families with more significant behavioral challenges (~2 pages)
      • What is Parent-Child Interaction Therapy — Description of this popular intensive behavioral training program (~2 pages + 2 minute video)

    • Readings (can be done over the course of the week)

      • Evidence of Parent Training Programs by the CDC — Pages 3-8 are most relevant for residents and pediatricians
      • Cognitive Development — Peds in Review article
      • Social Emotional Development — Peds in Review article

    • FYI Resources:

      • Encounters with Children by Marty Stein — Great book for facilitating well child visits
      • Whole Brain Child by Dan Siegel — Great book for understanding early child brain development and discipline. Good resource for parents as well
    • **Guided Learning Sessions:
      • Behavioral Difficulties in a Toddler with Dr. Erika Phelps Nishiguchi

• • Language and Speech Development (Day 14)

    • **Bilingualism — 5 minute TED talk on the benefits of bilingualism
    • **Bilingual Language Development — 20 minute module on language milestones of bilingual children, language mixing, and cognitive advantages
    • **Language & Learning Disorders — CHOP lecture by a DBP on language acquisition milestones, red flags in language development, etiology, and interventions. (Review slides 1-11 and 18-20)
    • **Difference between Speech and Language — Brief overview of the difference between speech and language
    • Speech Heard at Different Levels of Hearing Loss — 40 second Flinstones video demonstrating how “he can hear me!” may not equate to “he can understand me”
    • Hearing Screening Beyond Infancy — AAP report on hearing evaluations that includes descriptions of different types of hearing tests and which ages they should be used (ie, OAES, play audiometry, VRA, etc)
    • Monitoring Hearing Guidelines — Guidelines created by UW CHDD
    • Optional Resources:
      • A Speech Pathologist teaches her dog to speak using Augmentative Communication — Fun Video!
      • Hearing Loss Chart — Summary table of effects of hearing loss by dB
    • **Guided Learning Session: Audiology Lecture with Lisa Mancl, MS, CCC-A

• • Socioemotional Development & Autism (Day 15)

    • **Understanding Emotional Development — 20 minute module on how children use social cues, socially reference, and how they use these cues to interact with others

    • Autism

      • Autism Navigator Course — Register for a free account and complete the course to at least slide 15 (~45-60 minutes)
      • Social Communication Disorders: It’s Not Always Autism — Nice overview of components of social communication. The two PDFs linked in the second paragraph provide a nice overview of components of social-emotional and communication development. Also provides an excellent description of various treatment approaches and modalities.
      • **Autism Spectrum Disorder — CDC Modules on identifying, diagnosing, and managing Autism Spectrum Disorder
      • Optional Resources:
        • Fostering Self-Determination in Children with Disabilities — Ideas by parents for parents

• • Common Neurodevelopmental Disabilities (Day 16)

    • **Cerebral Palsy in Children: A Clinical Overview (2020) (8 pages)
    • **Health Supervision for Children with Down Syndrome — AAP Clinical Report
    • **Providing a Primary Care Home for Children with Spina Bifida — AAP Clinical Report
    • Optional Resources:
      • Normal & Abnormal Neurological Exams: Birth to 30 months — View some video clips; keep in your toolkit as a reference for doing neurological exams
      • Cerebral Palsy Foundation Video Library — Includes videos on CP across the lifespan, interventions, communication, supporting independence, family dynamics, and school
      • CP Channel App for Patients and Families
      • Providing a Primary Care Medical Home for Children with Cerebral Palsy
      • AAP Resources on Spina Bifida (including webinar training)

WEEK 3 OBJECTIVES: The World of Middle Childhood (Ages 6-12)

1. Understand the basics of executive function development
2. Learn which disorders coexist with ADHD and why multimodal treatment of ADHD is essential
3. Learn the difference between learning disability and intellectual disability
4. Gain a basic understanding of special education terms
5. Understand social and communication development in middle childhood
6. Understand how to talk to children in the middle years about difficult topics
7. Be familiar with ACES and trauma-informed care
8. Feel more comfortable completing a physical exam in a child with a disability
9. Know some resources for promoting physical and social development for children with disabilities

• Individual Learning

  • Development of Executive Function (Day 19)

    • What is Executive Function? — 5 minute video overview of executive function from the Center for Developing Child at Harvard
    • Executive Function in Childhood — 20 minute podcast by a developmental pediatrician on what pediatricians need to understand about executive function
    • **Cognitive Development in Middle Childhood — 30 minute read. Nice summarized map/table of cognitive development in this age group
    • **Emotional Development in Middle Childhood – -30 minute read. Nice summarized map/table of emotional development in this age group
    • Optional Resources:
      • Social & Emotional Development: Middle Childhood –From Bright Futures
      • How to Help Children Thrive by Understanding Executive Function — 17 minute talk by former educator and neuroscience researcher Adele Diamond on neurobiology of executive functions and how to promote EF development in children
    • **Guided Learning Session:
      • IEP Evaluations with Dr. Angela Armen

• • Attention Deficit Hyperactive Disorder (Day 20)

    • **ADHD: Pediatric Mental Health Minute Series — 15 minute overview on ADHD epidemiology, diagnosis, and treatment
    • Coexisting Conditions in ADHD — 2 page overview on which conditions commonly co-occur with ADHD and treatment recommendations
    • Behavior Therapy for ADHD — 1 page fact sheet by the CDC on what pediatricians need to know about behavior therapy
    • The ABCs of ADHD Medications — 20 minute podcast interview on basics of ADHD medications by a pediatric neurologist
    • What Professionals Need to Know, Say, and Do — 1 hour podcast (screen break!) by psychologist Jerome Schultz on behavioral strategies, classroom management, and promoting self-efficacy in children with ADHD
    • **Combating ADHD in the African-American Community — 17 minute podcast interview of parent advocate Evelyn Polk-Green on perceptions of ADHD in the African-American community
    • **AAP Practice Guidelines on ADHD Evaluation and Treatment
    • **Medical and Neurological Mimics of ADHD — Book chapter by Dr. Mark Stein
    • **ADHD Stimulant Medication Combinations  — 2 page resource on Short-Acting and Long-Acting stimulant medications for ADHD treatment
    • **ADHD Medication Guide — 2 page resource on ADHD Medication
    • **ADHD Rx At a Glance — 1 page resource on ADHD Pharmacotherapy options
    • Optional Resources:
      • SDBP Guidelines on Complex ADHD Management — Process of Care Algorithm
      • Assessment and Treatment of Children and Adolescents with Complex ADHD — SDBP Clinical Practice Guidelines

• • Learning Disabilities (Day 21)

    • **What Learning Disabilities Are and Aren’t — 7 minute video overview about the different types of learning disabilities
    • **Learning Disability versus Intellectual Disability — 1 page article on the difference between LD and ID
    • Language & Learning Disorders — CHOP lecture by a DBP on learning disabilities and screening in the primary care office (Slides 28-45)
    • Growth Mindset — 10 minute TED talk by Carol Dweck on the importance of promoting the growth mindset to help children problem solve
    • Optional Resources:
      • LD Navigator — A tool from the NCLD for the pediatric PCP
      • CrashCourse Psychology: The Intelligence Controversy
      • Misunderstood Minds — Module-like activity based on the PBS documentary to help adults understand what it’s like to be a child with a learning disability. Play around with it and see what it may feel like
      • Peds in Review Article about Intellectual Disability
      • Evaluating Vision at All Ages — AAP Clinic Report on how to do in-clinic vision evaluations at different ages and when to be worried

• • Social & Communication Development (Day 22)

    • **Social Development in Middle Childhood — 15 minute read. Nice summarized map/table of social development in this age group
    • **Communication Development in Middle Childhood — 15 minute read. Nice summarized map/table of communication development in this age group
    • Bullying TOW

    • Disabilities in Middle Childhood

      • School-Age with Spina Bifida — 1 page article and 2 minute video
      • Neuromuscular Disability Physical Exam Skills — MedEd Portal publication. NOTE!: Please select “appendices” and download the PowerPoint to view the narrated video
      • Activities and Recreation Opportunities for Youth with Disabilities — Explore at least 3 of the links under “Community Resources on Activities & Recreation“

• • ACEs and Supporting Children (Day 23)

    • Trauma

      • **ACEs TOW
      • National Child Traumatic Stress Network — Take a look at some of the resources available to familiarize yourself with this fantastic resource, and then watch this 30 minute webinar on How to Talk Trauma with an MD
      • Mini Series on Resilience — 3 short videos by the Center on the Developing Child
      • PTSD Peds in Review

    • Anxiety / Difficult Topics

      • Delivering Difficult News to Young Children — 1-2 pages long
    • Optional Resources:
      • Mindfulness for Kids
      • Presentations of Anxiety in Children at Different Ages

• PREP Questions – 3 case-based questions
• Optional Movie Night!
  • Continue Raising of America Documentary
  • Frontline: Inside the Teenage Brain — 1 hour special
• Weekly wrap-up with the fellows (1 hour): Wrap-Up discussion. Time to reflect on how the month went. Feedback for any recommendations for next month, missed topics, less useful topics, etc. Any last questions. Let residents know about option of NDV elective. Point residents to Sam’s website as a resource for future, as well as, archive of this month’s curriculum. Encourage residents to reach out with cases, topics, etc they’d like fellows to present at AM report, noon conference, etc.

WEEK 4 OBJECTIVES: Adolescence / Transition and DBP Wrap-up

1. Reflect on how you can support positive self and sexuality identity in teens with disabilities
2. Reflect on how you can help parents appropriately support their teens as they navigate this transition period
3. Be aware of resources to help with transitioning medical care from the pediatric to adult setting and issues of legal guardianship
4. Think about societal implications for individuals with disabilities

• Adolescence and Transition to Adult Care (Day 26 & 27)

  • Individual Learning

    • Identity and Sexuality
      • Overview of Sexual Development in Childhood — Developing a healthy sexuality is a key developmental milestone for all children and adolescents and depends on acquiring information and forming attitudes, beliefs, and values about consent, sexual orientation, gender identity, relationships, and intimacy over the course of their childhood. This will find a comment bubble where we have added “Red Flags” for sexual abuse
      • Storytime: Disability, Dating, Relationships, and Sex — 8 minute video
      • **Sexuality and Disability in Adolescents — 11 pages
      • Sexuality and Disability: Forging Identity in a World That Leaves You Out — 22 minute TEDxYale video
      • Thoughts on Becoming a Parent as an Adult with an Intellectual Disability — Listen or read the transcript for the interview with Ivanova, who is one of the UW LEND program self-advocate faculty members
    • Adolescent Transition to Adulthood
      • **Informing Families: Navigating Your Way 14-21 — 15 minute video and resource PDF
      • UW Adolescent Health Transition Project
    • Adolescence and Society
      • Impairment versus Disability: My Body Doesn’t Disable Me, Society Does — 5 minute video
      • From Disability to Criminality: Disability and the Criminal Justice System — ~2 pages / infographic
    • Optional Resources
      • Transition Readiness Assessment For Caregivers
      • Transition Readiness Assessment for Youth
  • **Guided Learning Session: Adolescent Medical, Educational, and Community Transition with Amy Carlsen, RN

• Optional Movie Night!
  • **Crip Camp: A Disability Revolution 2020 – Netflix Documentary (Trailer)
  • **Love on the Spectrum – Netflix reality show featuring young adults with ASD (Trailer)