Basic Theories and Concepts of Development

• Theories: maturational (Gesell), behaviorist (Watson, Skinner), psychoanalytic (Freud, Erickson), cognitive (Piaget), and eclectic (Werner)
• These theoretical positions take on clinical importance when interpreting the significance of a wide variety of studies on infants, intelligence, environmental influences, interventions, etc.
• Four streams of development: motor, language, problem solving, and personal-social

History of Developmental Disabilities

• Importance of understanding the roots of ancient and still persisting attitudes toward children, particularly children with disabilities

Cerebral Palsy

The prototypic developmental disability: this brain damage syndrome is more encompassing, though less frequent, than mental retardation.

• History, definition, diagnostic criteria, classification, associated disabilities, pathology, and prognosis
• Contributions of various medical (orthopedics, neurology, ophthalmology, psychiatry, dentistry, etc.) and non-medical (physical therapy, occupational therapy, recreational therapy and adapted physical education, nutrition, speech therapy, psychology, audiology, special edcation, and social services) disciplines

Mental Retardation

• History, definition, classification, and subtypes
• Medical evaluation and neuropsychological assessment to arrive at etiologic information useful in diagnosis and prognosis
• Nature versus nurture controversy
• Various methods of intervention (e.g., parent counseling, behavior modification, special education, etc.)
• Social policy and ethical issues dealing with topics such as normalization, mainstreaming, sterilization, etc.
• Community services, such as the ARC, group homes, and sheltered workshops

Developmental Screening

We emphasize the importance of infancy, and early identification of developmental issues and the most appropriate and useful tools to accomplish this.

Learning Disabilities

• Problems with definition and criteria for establishment of the diagnoses covering the spectrum of learning diabilities and attention deficit/hyperactivity disorder (ADHD)
• Incidence and nosology of the disorders
• Special aspects of the pediatric evaluation including subtle abnormalities on physical and neurological examinations, brief psychometric and educational screening evaluations, visual-motor perceptual tests for office use, brief psychosocial assessment, and laboratory testing
• Long-term prognosis of educational remediation and various conventional interventions
• Contact with the public school system and participation in school placement meetings is encouraged

Autism

• History, etiologic theories, differential diagnosis, and long-term prognosis
• Contrasting with other psychoses of childhood such as degenerative psychosis of childhood and juvenile schizophrenia
• Placing in proper perspective of the general diagnostic category of communication disorder

Seizure Disorders

The large and varied population of developmentally disabled children demonstrates a high incidence of seizures which are often (a) complex, (b) difficult to control, and (c) confusing to diagnose and monitor. Topics covered:

• General concepts of epileptology
• Emphasis on certain seizure disorders that are unusually common in children with mental retardation syndromes (e.g., infantile spasms, the Lennox-Gastaut syndrome

A close working relationship with the Division of Pediatric Neurology is a notable feature in the trainee's experience.

Legal and Ethical Issues

The pediatric developmentalist requires an understanding of the attitude of society toward the disabled and of his/her own difficult role as advocate for this group of patients within the general medical community as well as the lay community. These attitudes are reflected in the history of legislation dealing with the handicapped individual and in the manner in which federal and private funding agencies approach the distribution of dollars for various programs for the handicapped, including medical research activities.

Special Sensory Impairments

• Audiologic, linguistic, and visual assessments of children with blindness and deafness
• Spectrum of severity of visual and auditory impairment as it influences neuropsychologic testing
• Vision and hearing impairments as further complications of the developmental progress of children with multiple disabilities

General Pediatrics and Subspecialties Neonatal/Perinatal Medicine, Pediatric Genetics, Pediatric Orthopedics, and Pediatric Neurology

These are the foremost of many medical disciplines that constantly interface with the patient population served by the developmental pediatrician. Special emphasis is placed on these areas so the trainee may acquire complementary skills to better evaluate the developmentally disabled population and to be familiar enough with these and other disciplines to be able to facilitate easy communication with consultants. Maintenance of general pediatric skills is encouraged, especially in view of the higher-than average frequency of general medical problems faced by this population.

Behavioral Pediatrics and Family Dynamics

Given the high incidence of behavior problems in disabled children, and the great family stresses involved in parenting such individuals, familiarity with behavior evaluation and intervention is taught.

Systems Theory and Process

We believe the understanding of group and personal processes is a critical aspect of leadership.

• Group processes: family, interdisciplinary decision-making, how to interact with the community
• Personal processes: assessment, interpretive skills, data judgment, interaction with other medical and non-medical professionals, etc.
• Communication skills in the context of teaching, interpreting information to parents, and leading the interdisciplinary team

Research

An individual research endeavor is a required element of the fellowship. The weekly Fellows' Seminar series includes topics focused on research questions, study design, data interpretation, data presentation, etc. Fellow's take courses in clinical research design, epidemiology, and biostatistics.