Behavioral-Developmental

During this one-month rotation, you will shadow attending physicians in development and psychiatry, and a fellow in inpatient settings at Oishei Children’s Hospital.

You should attain competence in the following areas subsumed by child psychiatry. These include a working understanding of:

• the major diagnostic categories of childhood disorders
• psychotropic medications
• normal psychological, social, cognitive and motoric development
• how and when to use mental health professionals
• the establishment of therapeutic relationships in working with parents and children
• behavioral principles for addressing common childhood problems such as enuresis, encopresis and school phobia

You will gain proficiency in the following areas:

• ability to elicit pertinent psychosocial, cognitive and developmental histories
• ability to observe parent-child interaction for pertinent findings
• beginning appreciation of normal childhood development
• initial understanding of major diagnostic entities including: Attention Deficit Disorder/Hyperactivity, learning disabilities, depression, conversion, childhood psychosis, school phobia, enuresis, encopresis, suicide and language disorders
• ability to establish positive working relationships with parents and children in the hospital
• initial understanding of how to optimally present a catastrophic diagnosis including how and when to include children, siblings and extended family
• an appreciation of the phases and timing of the grief process
• a working understanding of behavioral principles in dealing with problems of children in the hospital such as non-compliance, aggression, oppositional behavior
• how to make a referral for psychiatric evaluation of hospitalized children so as to optimize the likelihood of successful engagement in treatment
• an initial understanding of the impact of chronic disease on children in the family
• an understanding of the social service system including welfare, foster care, child Protective services, adoption
• a greater sophistication about psychosocial and cognitive development including the concepts of attachment, temperament, the process of separation- individuation
• a beginning understanding of the utilization of psychotropic medications in an outpatient practice
• a working understanding of the concept of “support” and “reassurance”
• how and when to refer an outpatient for mental health treatment so as to optimize chances of successful engagement
• beginning ability to distinguish expertise in rail of social worker, psychologist and psychiatrist
• understanding of behavioral principles utilized in the treatment of enuresis and encopresis and school phobia
• firm understanding of distinction of major diagnostic entities (as noted above)
• understanding of the concepts of family life cycle development
• appreciation of the effects of separation on children (i.e., divorce, hospitalization, death, day-care)
• an appreciation of children’s evolving concepts of death
• a solid understanding of the referral process for mental health treatment and an awareness of specific professionals and their capabilities
• an understanding of the use of the telephone in clinical outpatient practice
• how to organize an outpatient practice so as to be able to address common behavioral problems
• a working knowledge of behavioral techniques to address common problems of infants and young children (for example, sleep, eating, toilet training and temper tantrums)
• developing a working understanding of the school system and specialized services available to children. Included in this would be an appreciation for the central role of school in children’s lives
• a working understanding of the widespread adolescent problems of drugs and alcohol, sex and pregnancy as well as referral sources available to address these issues
• solid, demonstrated ability to evaluate suicidality in adolescents and children

Common diagnoses or problems:

• Pediatric behavioral disorders
• Autism
• Cerebral Palsy
• Developmental delays

You will see a total of about 80 patients during this rotation.

• PGY-2

4 weeks

• Patients up to age 18